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What causes high blood pressure while treating polymyalgia rheumatica?

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Posted on Mon, 9 Jan 2017
Question: 4 years ago I* was diagnosed with Polymyalgia Rheumatica and was on a steroid regiment for one year. That is when my blood pressure started to go up and down. I have not had a reacurrance of it . My blood pressure conti8nues to be a constant problem. It will be too high or to low. We have tried several mixtures of meds. It may stabilize for a couple of months then it decides to be too high or too low. We have done all kinds of labs and xrays. I came off all meds last month after a bout of hyponatremia. currently getting back on Carvedilol 12.5 am & pm And losarten 50 mg am and pm. Right now it is still hopping all over. This am 126/82 tonight 186/94. I am an active and healthy 73 year old. My Husband and son are post open heart so we watch our salt aqnd fats. I am a retired nurse so read labels in more detail. We use 90 % fresh foods. Have a nurse BP check once a week or every other. Any ideas or suggestions that may help me??
doctor
Answered by Dr. Rishu Saxena (2 hours later)
Brief Answer:
Adrenal efficiency secondary to long term steroid therapy

Detailed Answer:
Hi Dear
Firstly thanks for choosing HCM for you queries
I have noted all your details
As mentioned by you , you were on steriods for one year
Lets first understand how blood pressure is maintained by our body ,this will help you to understand your symptoms better.
Our kidney on top of them have to small glands called ADRENAL , these glands are responsible for secretion of hormones named ALDOSTERONE ,CORTISOL etc.

Aldosterone along with Cortisol affects the body's ability to regulate blood pressure.It plays a pivotal role in maintaining blood pressure constant through out the day, It sends signal to organs, like the kidney and colon, that can increase the amount of sodium(sodium retains water and can increase blood pressure if there is a drop in blood pressure) the body sends into the bloodstream or the amount of potassium released in the urine.Aldosterone is closely linked to two other hormones: renin and angiotensin, which create the renin-angiotensin-aldosterone system. This system is activated when the body experiences a decrease in blood flow to the kidneys, such as after a drop in blood pressure,and maintains the blood pressure to normal again

This was a brief explaination for how the system works

As you said you were on steriods for 1 year for polymyalgia rhematica.
Adrenal supression is one of the most common adverse effect of long term steroid therapy,your adrenal glands naturally produce steroidal hormones like cortisol etc in small quantities daily,but when you start taking external steroids for long term,our brain fails to understand the difference between the externally provided steroids and naturally synthesized steroids,in some of the cases Adrenal gland stop producing the hormones totally, This phenomenon is called Fatigued Adrenals or Adrenal insufficiency.

As you were on steroid for one year in your case the hormone production is either suppresed or is not produced at all, therefore your body finds it difficult to maintain the blood pressure and there are fluctuations through out the day.
Your hyponatremia was also because of the disturbance in aldosterone renin angiotensin in your body.

My suggestion to you is to get a through check up under a ENDOCRINOLOGIST.
He would prescribe you
A) ACTH(hormone secreted by pituitary that stimulate adrenal gland to produce hormone) stimulation test- commonly used test for diagnosing adrenal insufficiency.You would be given an intravenous injection of synthetic ACTH, and samples of blood, urine, or both are taken before and after the injection. The cortisol levels in the blood and urine samples are measured in a lab.

B)CRH stimulation test-When the response to the ACTH test is abnormal, a CRH stimulation test can help determine the cause of adrenal insufficiency. In this you would be given an IV injection of synthetic CRH, and blood is taken before and 30, 60, 90, and 120 minutes after the injection. The cortisol levels in the blood samples are measured in a lab.

C) serum renin and aldosterone levels will be done

D)MRI of abdomen can be done to rule out atrophy(injury) to adrenals

All these tests should be done in consultaion with a endocrinologist.

If you have any further query i will be happy to help you.Let me know if you need more explainations and details about your labile blood pressure problem.

thank you
Dr Rishu Saxena
Resident Cardiologist
kindly rate the answer if it was useful to you!
Above answer was peer-reviewed by : Dr. Remy Koshy
doctor
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Follow up: Dr. Rishu Saxena (4 days later)
I appreciate the answer. I will follow up with an endocrinologist. Saw endocrinologist 4 years ago when newly diagnosed.
XXXXXXX
doctor
Answered by Dr. Rishu Saxena (5 hours later)
Brief Answer:
Thank you!

Detailed Answer:
Thank you,
Please do see a endocrinologist ;and discuss the above mentioned reports!

In case you have any other query feel free to ask; i would be happy to help you!

Please do rate the answer and write a review.

I wish you a quick recovery!

Thank you,

Dr Rishu Saxena
Cardiologist
Above answer was peer-reviewed by : Dr. Remy Koshy
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Dr. Rishu Saxena

Cardiologist

Practicing since :2012

Answered : 696 Questions

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What causes high blood pressure while treating polymyalgia rheumatica?

Brief Answer: Adrenal efficiency secondary to long term steroid therapy Detailed Answer: Hi Dear Firstly thanks for choosing HCM for you queries I have noted all your details As mentioned by you , you were on steriods for one year Lets first understand how blood pressure is maintained by our body ,this will help you to understand your symptoms better. Our kidney on top of them have to small glands called ADRENAL , these glands are responsible for secretion of hormones named ALDOSTERONE ,CORTISOL etc. Aldosterone along with Cortisol affects the body's ability to regulate blood pressure.It plays a pivotal role in maintaining blood pressure constant through out the day, It sends signal to organs, like the kidney and colon, that can increase the amount of sodium(sodium retains water and can increase blood pressure if there is a drop in blood pressure) the body sends into the bloodstream or the amount of potassium released in the urine.Aldosterone is closely linked to two other hormones: renin and angiotensin, which create the renin-angiotensin-aldosterone system. This system is activated when the body experiences a decrease in blood flow to the kidneys, such as after a drop in blood pressure,and maintains the blood pressure to normal again This was a brief explaination for how the system works As you said you were on steriods for 1 year for polymyalgia rhematica. Adrenal supression is one of the most common adverse effect of long term steroid therapy,your adrenal glands naturally produce steroidal hormones like cortisol etc in small quantities daily,but when you start taking external steroids for long term,our brain fails to understand the difference between the externally provided steroids and naturally synthesized steroids,in some of the cases Adrenal gland stop producing the hormones totally, This phenomenon is called Fatigued Adrenals or Adrenal insufficiency. As you were on steroid for one year in your case the hormone production is either suppresed or is not produced at all, therefore your body finds it difficult to maintain the blood pressure and there are fluctuations through out the day. Your hyponatremia was also because of the disturbance in aldosterone renin angiotensin in your body. My suggestion to you is to get a through check up under a ENDOCRINOLOGIST. He would prescribe you A) ACTH(hormone secreted by pituitary that stimulate adrenal gland to produce hormone) stimulation test- commonly used test for diagnosing adrenal insufficiency.You would be given an intravenous injection of synthetic ACTH, and samples of blood, urine, or both are taken before and after the injection. The cortisol levels in the blood and urine samples are measured in a lab. B)CRH stimulation test-When the response to the ACTH test is abnormal, a CRH stimulation test can help determine the cause of adrenal insufficiency. In this you would be given an IV injection of synthetic CRH, and blood is taken before and 30, 60, 90, and 120 minutes after the injection. The cortisol levels in the blood samples are measured in a lab. C) serum renin and aldosterone levels will be done D)MRI of abdomen can be done to rule out atrophy(injury) to adrenals All these tests should be done in consultaion with a endocrinologist. If you have any further query i will be happy to help you.Let me know if you need more explainations and details about your labile blood pressure problem. thank you Dr Rishu Saxena Resident Cardiologist kindly rate the answer if it was useful to you!