Patient: My blood pressure has been running high for the last 3 months for sure ie. 189/111, 178/110, the rest mostly 150 plus/90 plus with a few in the 140 plus/85plus. My cardiologist put me on chlorthalidone 25mg, losartan 50mg, and amLODIPine besylate 5mg. He took away the zinc .6.25mg which I have been for umpteen years. I have been on the new drugs for a month to no avail. Went to my nephrologist who did blood work and 24-hr urine specimen I was diagnosed with lupus in 2000 and fibromyalgia in 2003. Lupus has not been any trouble the last years but I was diagnosed with RA in 2011 and have been on many drugs orally to no avail and 3 biologics and am on actemera intervenously now at one each month (4) to date. My neurologist had me on propranolol 80 mg for migraines which argue I don’t have. But there is some hypertension control from that drug so Drs. say. Now the 24 hr urinal says. Protein/creatinine level is high at 100 mg/g, norepinephrine is 150mcg, E+NE is 150 mfg, metanephrine is 42 L, nor metanephrine is 913 H, with metanephrines, total 955 H. Lab notes at this point say: a four fold elevation of normetanephrines is extremely likely to be due a tumor while a four fold elevation of urinary metanephrines is highly suggestive, but not diagnostic of the tumor. Measurement of plasma metanephrines and chromogranin A is recommended for confirmation. Then my vanillylmandelic acid is 7.4 H, then my cortisol, free, urine (per the lab note) is. Results are below reportable range for this analyze, which Is 1.0mcg/L. On the test called Plasma Renin activity LC/MS/MS is 145.64 H. And Aldosterone LC/MC/MS is 39 H. Now this nephrologist wants to put me Labetalol 200 mg and wants a CT scan of my adrenaline glands (says he wants to look at them himself). My question to you is a fourth blood pressure that strong , will that be detrimental to my hypertension bringing it way down then forget about the possible tumor (by the lab. tecs). Then reading in the nephrologist’s personal notes that I have white blood cell casts which is “unclear to him.” I’ve been so sick for so long and when I read what lab results are and the tec notes, I will rely the tec knows what they are talking about over the dr as I will always believe the pharmacist’s remarks. She can’t understand the reason for all the hypertension meds after lab work I have. Couple years ago, my primary dr. put me on a drug she thought I needed and my pharmacist called me and informed me the new drug was a conflict with drugs I currently was on.So therefore I’ve always been told the pharmacist knows the proper call on drugs, for God sakes that is all they deal with. Same goes for lab techs lab tests is all they deal with. So I am begging you for your opinion of this crisis. I am drinking more water each day than normal, my urine is strong smell, is sudsy on top, a mucous, white in color on the tissus, very tired and jittery all day , horrible sweat episodes to the point water drips off my face and dripping water from ends of hair. Then when that ends, I am so worn out, completely exhausted. All of these issues the last couple months. And the trembling in legs and hands. Thank you for your help, I await your answer, suggestion etc
Doctor: Hello. Welcome to Ask The Doctor.I understand your concern.You have been mainly suffering from Lupus Nephritis with Rheumatoid Arthritis. Your passing protein in Urine. This would require treatment.At far as Urinary catecholamines are concerned yes they are raised mostly in neuroblastoma, Pheochromocytoma that can be a cause behind your Hypertension.This would require further evaluation.Another way to detect neuroblastoma is the mIBG scan (meta-iodobenzylguanidine), which is taken up by 90 to 95% of all neuroblastomas.For pheochromocytoma Imaging by computed tomography or a T2 weighted MRI of the head, neck, and chest, and abdomen can help localize the tumor.In your case scenario you would also require a Kidney biopsy to rule out thr stage of lupus nephritis to decide for the treatment.I must bring to your notice that tests like Rheumatoid factor for Rheumatoid Arthritis can be false positive in presence of lupus.I would advise you to see your doctor who would investigate you further and treatment decision would be based on that.I hope it helps.Good Luck.