DEAR DR. DONOHUE: My doctor recently told me that I have Conn’s syndrome. He said that my adrenal gland or glands are producing too much aldosterone. He prescribed spironolactone, and it has decreased my blood pressure. Would you elaborate on the disease? Can the adrenal glands be removed? Is there any danger in taking spironolactone? – Anon.
ANSWER: Just about everyone has heard of the adrenal glands, which are located on top of the kidneys. Just about everyone knows they make cortisone. Few, however, have heard of aldosterone, another adrenal gland hormone. It controls the amount of sodium and potassium the body holds on to, and it regulates the amount of water in the body. It is intimately involved in blood pressure control.
Too much aldosterone (Conn’s syndrome, or aldosteronism) is a potentially curable cause of high blood pressure. Conn’s high blood pressure can have a few unusual twists. Diastolic pressure rise (the second number) is usually greater than systolic rise; headaches are a frequent feature; and excessive urination is another sign of Conn’s. Because potassium loss is frequently a part of the picture, blood potassium levels are low, and muscles are weak because of the low potassium.
Quite often a benign (noncancerous), one-sided adrenal gland tumor is responsible for the problem, and when that is the case, removing the tumor almost always brings a cure – one of the few cures for high blood pressure. A CT scan or MRI of the adrenal glands can reveal the tumor. Sometimes, however, the problem arises from an increase in the number of adrenal gland cells, and that increase takes place in both glands. It is impossible to remove both glands, so medicine is the answer to hyperplasia, as this process is called.
Spironolactone blocks aldosterone’s action. It’s been around for many, many years and has a safe record. The question of its influence on breast cancer has been raised, but no cause and effect has been established.
The blood pressure booklet describes high blood pressure in detail. Readers can obtain a copy by writing: Dr. Donohue – No. 104, Box 536475, Orlando, FL 32853-6475. Enclose a check or money order (no cash) for $4.50 U.S./$6.50 Can. with the recipient’s printed name and address. Please allow four weeks for delivery.
DEAR DR. DONOHUE: Do you recommend a periodic stress test for an asymptomatic patient as part of a routine physical exam? – S.T.
ANSWER: No advisory body recommends the routine use of stress tests for people who have no symptoms or signs of heart disease. Stress tests done on such people yield too many falsely positive results, and the costs engendered by indiscriminate testing would be staggering.
Stress tests are tests done with a person on a treadmill. The person’s ECG is continuously monitored during the test. Every three minutes, the speed and incline of the treadmill are increased, “stressing” the heart. ECG changes occur if the stressed heart doesn’t get enough blood due to blocked heart arteries. It’s a wonderful test, but its wonders are confined to those who have symptoms of heart disease or who are at high risk of having it.
DEAR DR. DONOHUE: What causes plantar warts? How do you get rid of them? – T.R.
ANSWER: Papillomaviruses cause all warts. There are more than 100 strains of this virus family, and each strain behaves a bit differently and seeks out a unique body site to invade. Some papillomaviruses – a few of the ones that cause genital warts – can lead to cancer.
Plantar warts are warts on the soles of the feet. Plantar wart viruses do not cause cancer, but they do cause pain.
These warts often disappear on their own, but that can take two or more years. In treating a plantar wart, it’s important to choose a method that doesn’t leave a scar. A scar on the bottom of the foot can be as annoying as the wart. Doctors can freeze them with liquid nitrogen or dry them with an electric current. Liquids and creams that contain salicylic acid can also remove them. Aldara cream, a prescription medicine, is another effective treatment. This is only a partial list of treatments.
Dr. Donohue regrets that he is unable to answer individual letters, but he will incorporate them in his column whenever possible. Readers may write him or request an order form of available health newsletters at P.O. Box 536475, Orlando, FL 32853-6475.
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