Low Aldosterone Levels

[Tessa]

Hi all

I just got the results of my aldosterone levels. It has been marked as "low" and showed 51.00 pg/ml

Furthermore, I have a low level of:

Potassium (urine): 17 mEq/L (normal values: 25-100)

MCH (Mean Corpuscular Hemoglobin): 26.7 pg (normal values: 27 - 33.5)

lymphocytes: 17.4 % (normal values: 20-53)

The renin-angiotensin-aldosterone system plays an important role in the regulation of plasma volume.13

Aldosterone paradox in POTS. A, Under normal circumstances, low plasma volume is sensed in kidney (and in heart and aorta) and stimulates increase in plasma renin activity (renin), angiotensin II (A-II), and aldosterone (ALDO). Increase in plasma renin activity and aldosterone promotes salt and water retention, which leads to increase in extracellular fluid volume and plasma volume. B, In POTS, there is failure to sense and appropriately respond to low plasma volume. There is no appropriate increase in plasma renin activity, angiotensin-II, and aldosterone given the hypovolemia. Because plasma renin activity and aldosterone are not increased, salt and water retention is not increased, and plasma volume is not increased.

Source: AhaJournals

What do you think about these results?

Do you have a low aldosterone level? What about Potassium and lymphocytes?

Thank you,

Love,

Tessa

[flop]

Hi Tessa,

I don't think that aldosterone levels are routinely measured but your low level certainly makes sense in someone with POTS. Low aldosterone will contribute to your body not maintaining an adequate blood volume, taking fludrocortisone (or in your case liquorice) should help to counteract the low aldosterone. Fludrocortisone acts like aldosterone but it isn't the same so won't show on a test of aldosterone levels (ie taking florinef / liquirice will increase blood volume but won't increase aldosterone levels).

The potassium level that needs to be monitored is your serum potassium (a blood test). Florinef and liquorice can cause you to excrete more potassium than normal in your urine, leaving you with a low serum potassium level. I don't think that you need to be too bothered about the urine potassium level - it may give your doctor more information about your condition but so long as your serum potassium is normal it won't make you feel ill.

The MCH is a measurement of the average amount of haemoglobin within the red blood cells. Your value is so close to normal that it is nothing to worry about (only 95% of healthy people have results in the normal range anyway). If your Hb (haemoglobin) level is normal you don't need to worry about the other sub-results.

Lymphocytes are a type of white blood cell. Values quoted as a percentage of the total white cells aren't that helpful. Actual numbers of individual types of white cells are more useful. If your white cells overall are slightly up or down the percentages can be very abnormal when the actual numbers aren't that bad. White cells change frequently due to minor things like a recent cold or other virus. A slight percentage change is nothing to worry about.

The best thing would be to ask the doctor that ordered the tests to explain the results to you but I don't think that there is anything to be worried about in the meantime. If you get an explanation about the aldosterone levels please write it down and share with us on the forum - I would be interested to know more about what the test results mean.

I hope that lot made sense,

Flop

[delphicdragon]

Tessa-

I think that Flop has given you a plethora of information. Thanks!

I too, have low aldosterone levels. They've crept up in recent years as I'm learning how to manage the disease but for a while mine were 2, with a normal range of 5-50. I know the tests all have different ranges and I don't know exactly what was tested, but now they are 9, which I've been told is much better. Also, aldosterone levels are lowest when laying down and highest when standing, so if the test was taken lying down that may be why the level is low. I know for my aldosterone tests they had me stand for two hours before they drew blood. Standing was the worst part of that test - the nurse didn't want me walking around or leaning on anything as it might change the levels.

Also, as Flop said, keep an eye on the Potassium levels. My grandma was on high blood pressure medications that drained her potassium levels and she had a severe heart arrhythmia as a result. I hope you feel better.

Sara

[Tessa]

Hi

Thank you for answering I am not alone here

As mentioned on the previous post, low aldosterone levels are related with POTS and I have found the following highly interesting article which I wanted to share with all: (extract)

Aldosterone is the salt-retaining hormone and is a mineralocorticoid. Excesses of aldosterone leads to high blood pressure and low potassium. Deficiencies of aldosterone are much less appreciated than deficiencies of cortisol, and lead to low blood pressure and high pulse, especially on standing, the desire to eat salt (salt-craving), dizziness or lightheadedness on standing, and palpitations. Severe cases may lead to high potassium and low sodium in blood tests. When the adrenal is not making aldosterone, renin, a kidney hormone, increases. Excesses of cortisol and aldosterone may occur independently, that is a patient may have only excess aldosterone, only excess cortisol, or excesses of both. Similarly, deficiencies of cortisol and aldosterone deficiencies may be independent.

Flop, thank you for your comments about the results. Your words have been most helpful to determine the meaning of the values.

In relation with aldosterone, the Laboratory had marked that ALDOSTERONE levels were low regarding the normal values (but without mentioning the normal values) & my GP was more worried about not knowing the normal values for aldosterone. He tried to figured them out calculating to another system and he only added, yes they are low. But he was extremely nervous, and I am afraid he did not know the meaning for low aldosterone levels, as he only mentioned that high aldosterone levels could mean cancer and low ones, muscle weakness, chronic fatigue syndrome, etc.....

This is how the article continues:

Many patients with symptoms of fatigue and often salt-craving, "cognitive fuzziness", dizziness or lightheadedness on standing, or palpitations have low blood levels of aldosterone. The connection between low aldosterone levels and fatigue is as follows: with low aldosterone, the kidney loses salt, leading to low blood volume. This coupled with the idea that the leg veins don't constrict properly, leads to lower blood volume to the brain and fatigue and other symptoms. These patients often have a drop in their

blood pressure and an increase in their pulse when standing. They may also have decreased blood flow to the brain when measured by SPECT scan. Aldosterone deficiency may be made worse if patients restrict their salt intake.

My serum potassium level is 4.00 mEq/L (normal values are: 3.5-5)

I am glad that I don't need to be too bothered about the urine potassium level

Article continues:

Soon-to-be-published research (Friedman, T., et al., in preparation) shows a few patterns of abnormalities in the renin-aldosterone axis. A little more than half the patients with fatigue had low blood levels of both renin and aldosterone. This is called hyporeninemic hypoaldosteronism and is probably due to dysfunction of what is called the autonomic nervous system, which sends messages from the brain to the kidneys. Other aspects of the autonomic nervous system have been found to be deficient in chronic fatigue syndrome. About one-third of the patients studied were found to have low aldosterone and high renin. This indicates a deficiency in the aldosterone production in the adrenals themselves, with a compensatory rise in the renin coming from the kidney. The aldosterone defect can either be an isolated problem, or part of Addison's disease (often early Addison's disease), in which both cortisol and aldosterone production are diminished. The remaining patients (about one-sixth) had both high renin and high aldosterone. This is likely to be a compensatory rise in both of these hormones as a reaction to a low blood volume, most likely due to an inability of the kidney to retain salt.

Sara, From the information I found on the net and your answers, I understand that aldosterone levels should be higher, but I have to admit that the blood test was carried out while lying... Possibly the reason for being lower, or maybe not.

The fact is that I am weak, I am having muscle weakness and cramps, suspect a low blood volume, etc.

If you are interesting in reading the full medical article, please visit the following link:

Friedman Article

I will continue looking for more information on aldosterone. If I find an interesting info. I will share it, but if you know something - please tell us.

Comments, doubts, ideas... You are welcome to add your answer.

Thank you for reading my long post.

Take care,

Love,

Tessa

[flop]

Tessa,

thanks for the link to the article - I'll read it later when I'm not so brain-fogged.

It isn't very helpful that the lab didn't give your doctor a reference range for the aldosterone test. Was it your GP that ordered the test or was it a specialist? Your GP should be able to phone the lab that did the test to find out the reference range for that lab. You can't really work out a range, especially as you don't say what units it was measured in. Each lab's reference range will vary depending on the units used, the specific assay that they run and their equipment, plus they calculate their own "normal" values from local healthy volunteers (at least they do here in the UK).

Most tests are only helpul if they are requested by a doctor who knows how to interpret the results - hopefully your GP can find some answers for you or refer you to a specialist who can look into it.

Flop

[Tessa]

Hi Flop

The thing is that I do not have a specialist who really knows about POTS.

My cardiologist who carried out the TTT and who determined that I "faint" said I that I have POTS. His Dx was mostly because I suggested it to him by showing him the information of Dr. Grubb. Even though he said I had POTS, he added that there is no difference as the treatment for all are the same... I am afraid he did not read the full article to know more about dysautonomias, as he mentioned that it does not disable people... And that it can be avoided simply by not standing up to quickly, drinking plenty of fluids and adding salt to my diet... He wondered how I could be feeling so bad between episodes (without fainting) as it should not disable a person that much...

Well, he has not much idea about dysautonomias. He believes that fainting is not a serious condition and that there is nothing to worry about.

But, the thing is that he was the only specialist really willing to help and who bothered about my conditions. He ordered the TTT and carried it out himself (while at the TTT, he scared to death after my reaction but I mentioned it already on a previous post)...

He prescribed Florinef, but as we have no access to it in Spain, he agreed trying with Licorice Root. As it can cause the same effects as Florinef, I asked him to keep my electrolytes under control and he suggested me to visit my GP for future check-ups...

He said goodbye, told me to return if there was an emergency and said that I would have to ask for an ap in 1 year time - but added that it was likely that I would be given an ap. with another cardiologist by that time, as there are more than one, they have different times... And he was unable to promise that I would get the next one with him...

With regard to the renin-angiotensin-aldosterone system, I read about it being a possible reason of having POTS. Even Dr. Grubb suggested it on an article. It was said that a low aldosterone level can cause a low blood volume, inability to absorb sodium/potassium in the correct way, to balance the blood pressure, to keep the muscles fit (even the cardiac muscle), etc.

As I had been taking Licorice Root for a while, I knew I had to check my electrolytes and went to my GP to ask a blood test. I wanted him to check my renin-angiotensin-aldosterone levels too. But the day that I went to my doctor, he had the day off. A substitute was there and having no idea of my GP?s patients but willing to help and not to cause any claim, she agreed to everthing I asked and ordered the test. Even though, she added that the test was a very special one and was not sure if they would carry it out or if it had to be ordered by a specialist...

When the results came in, my GP had no idea about it being ordered, as well as no idea about what it is used for. He calculated the results into nanograms...and said that they were low (which is already remarked on the results page issued by the Lab.) ... And changed the subject of our conversation...

The Laboratory only checked aldosterone levels, not renin & angiotensin...

And that?s the story.

I am feeling helpless now, because I think I have found something important with relation to my POTS but I have no specialist to help me.

Again alone. With the help of my husband, but both alone without a way to know what our next step should be or what a specialist would do now having these results.

After reading the information on the website I published on my previous post, It is clear that having a low aldosterone level is important but, what can we do now?

Thank you for your answers. You are being a great help and support, Flop

Love,

Tessa

[flop]

Hi Tessa,

Fludrocortisone / Florinef is an artificial substitute for aldosterone. I know that you haven't been able to find a source of fludrocortisone but as you already know Liquorice root is a natural source of a substance which has the same effect. I would work with your GP to get your liquorice root dose right for you (checking for symptoms, BP, and electrolyte balance) as this will make up for your body's low aldosterone level. It is rather like taking an aldosterone supplement. Don't bother trying to check the aldosterone level again as neither Fludrocortisone or Liquorice supplementation will make your aldosterone levels rise, they act the same but won't be measured in a lab assay.

Flop

[Tessa]

Thank you, Flop. Most helpful

My blood pressure has changed a lot since I am on Licorice.

Do you remember that I have always mentioned having 80-40 ?

Nowadays my bp has been:

100-60

105-69

101-61

109-69

Serum Electrolytes on the blood test showed fine, except the urine potassium which was low.

Furthermore, most of the symptoms I had have disappeared and I am feeling much better than before, except that I have muscle weakness, cannot exercise and still become easily tired and dehydrated.

Two days ago, the elevator was not running and we had to use the stairs to get up home. When we got home I was feeling exhausted, dizzy, thirsty and completely out of breath. My husband scared because I was pale...

But in general, I am better.

Love,

Tessa

[flop]

Hi Tessa,

your BP readings certainly seem to have improved since you started the liquorice - I'm impressed that it has had such an effect! Even more important though is you saying that you are feeling better - minimizing symptoms and maximising ability to do "normal" things is so important in dysautonomia. Hopefully tinkering with your bisoprolol, liquorice, fluid and salt will allow you to find the best combination for you.

Have you tried compression stockings? I wear the knee length 40mmHg ones and find that they help a bit especially if I need to exert myself, like getting up flights of stairs.

Have you tried different doses of your Bisoprolol? I'm not advising you to change the dose, but maybe have a chat with your GP about it. I was started on the baby dose of 1.25mg and it was increased to 1.25mg twice a day. After my latest tilt test my cardiologist is considering cautiously increasing it again but he warned me that too much of it lowers the blood-pressure.

Everyones's body responds differently to meds so finding the best combination is often a trial and error process.

I hope your improvement in symptoms continues,

Flop

[Tessa]

Hi Flop.

Thanks for your answer.

Yes, it is really a gift being able to do more things than before and feeling better.

I also agree that this is thanks to the combination of bisoprolol, liquorice, fluid and salt.

I never tried compression stockings but aren?t they difficult to wear in the summer? We are having around 35 degrees Celsius, sometimes even 38...

We have tried to swim a little the other day (on the beach) and even though it makes me feel tired, I enjoyed to be there. We are planning to repeat the experience in order to try to exercise a little. My muscles need it and as I am unable to exercise it seems to be the only way to exercise a little without feeling exhausted and with all the symptoms again.

We have never tried different doses of Bisoprolol because when I suggested it to the Cardiologist in order to reduce it, he refused.

I am on 2.25 mg. x2 (one dosis in the morning & one in the evening).

Thank you for caring about me, Flop.

I return to work on Tuesday. Just a little afraid of it but I think I will be able to cope with it as I am feeling better.

Love,

Tessa

[Sunfish]

hi tessa -

i know that things are far from ideal, but it is great that you have seen some improvements so just wanted to say that i'm very happy for you. if you are able to swim it's the best thing for many with autonomic issues. you may want to do a search as it's been discussed at length more than once. let me know if you have trouble with the search & i'll try to find the posts myself. i was able to swim a mile at one point even when needing to be in a wheelchair to get to the side of the pool; it was the one place (in the water) wherein i could feel almost normal. i miss it horribly as it was a big part of my life since before i could walk (i swam competitively & for fun & later coached, taught, & lifeguarded for years) but am not allowed in the water now at all b/c of the various tubes & IV lines in me. i have dreams about it though!!!

i hope your return to work goes as well as it possibly can. try to take care of yourself the best that you are able & realize that going back to work after a break is often wearing on anyone - even those that are healthy - so don't be too hard on yourself or get too concerned if it is particulary difficult at first.

congrats on your progress...every little bit helps & hopefully things will just keep getting better & better!

melissa

[Tessa]

Hi Melissa

Thank you for answering

Yes, it is an improvement. I am looking forward to going to the beach this week (after work) and have a nice bath. I hope to swim a little... You did a mile! And lifeguarded! You must have some nice rememberings of it. It is wonderful to remember these kind of things.

I used to swim a lot before worsening, I was even known as the "sirene", because I kept swimming for hours and hours, but now I cannot keep more than 1 minute swimming. I feel so tired. And then the next day, all my muscles are painful. But of course, I do not exercise at all, so that must be part of the problem.

Cannot forgive myself living so close to the beach and not swimming. I can see the sea from the window where I am writing to you. The sea has such a wonderful colour. I have to try!

I will see if I am too tired tomorrow after work and If I am not, my husband and me will try having a bath in the sea.

You might feel better step by step and return to your swimming. Not as hard as you did before, but at least to have some fun swimming a bit. Never give up your faith, Melissa.

Thank you for your good thoughts. The office has been closed while I have been away. Imagine all the work waiting for me... Plus I have a new boss willing to do a lot of new things... I have to try my best not to stress and to worry... It is easy to say and difficult to achieve, but I will have to if I want to keep on being healthy...

Going back after a break is always stressful ... But I will do my best. (They have no idea about my health issues at work and I cannot share it with them because it would cause me problems)

Thank you for your being so positive, Melissa. Every little bit helps and your words are most helpful too.

Take care, it is nice to read your posts and see that you are feeling better. I hope that you are going better every day too.

Love,

Tessa

[E. G]

Hi 

I am new to the forum so not sure how it works. Does anyone know anything about the fact that heparin ( blood thinner) is know to suppress aldosterone levels ?

Thanks 

E. G