DEAR DR. DONOHUE: All through high school my son talked about joining the Marines. When he graduated, he applied and was turned down because his blood pressure was high. We never suspected anything was wrong with him. Our family doctor sent him to an endocrinologist, who has diagnosed an adrenal-gland tumor. Will you explain this to us? — M.O.

ANSWER: Most people know that the adrenal glands make cortisone. Few people know they make other hormones, one of which is aldosterone. It’s a hormone that has many roles to play. It maintains the body’s sodium level. It regulates the potassium level. It participates in keeping blood pressure on keel.

About 1 percent of people with high blood pressure have an adrenal tumor that’s pouring out too much aldosterone. The condition is called aldosteronism, or Conn’s syndrome, after Dr. Jerome Conn, who was a professor at the University of Michigan Medical School. The tumor is usually a noncancerous tumor.

Looked at from one point of view, aldosteronism is something that has a definite upside: It’s a curable form of high blood pressure. Removal of the tumor normalizes pressure.

High blood pressure isn’t the only sign. The lowered blood potassium that comes with the syndrome causes muscle weakness. Your son’s potassium must have been near normal since he never complained of being weak.

If the diagnosis is proven and the tumor is removed, all the abnormalities of this syndrome are corrected. I can’t speak for the Marine Corps, but I cannot see why they would reject him after this matter has been taken care of.

DEAR DR. DONOHUE: I have been wakened from sleep with severe rectal pain. It doesn’t last long, but the pain is so intense that it feels like an eternity. My doctor examined me carefully and did a number of tests without finding anything wrong. Can you think of what this might be, and how it’s treated? — G.M.

ANSWER: Proctalgia fugax is my guess. It’s sudden attacks of excruciating rectal pain lasting from seconds to 15 minutes. Not much is known about this condition, because episodes are so brief that it cannot be studied. The pain occurs day or night. Some authorities believe it’s a cramp of the sphincter (SFINK-tur) muscles, the muscles that keep the rectum closed.

If you can live with it and the attacks are brief, it might be wise to do nothing. On the other hand, if attacks last long or are frequent, treatment with inhaled albuterol can stop the pain. Albuterol is an asthma medicine. Oral clonidine, chiefly a blood pressure medicine, also works. The trouble with oral medicines is the attack is usually over by the time the medicine is absorbed. Nitroglycerin ointment applied to the skin adjacent to the rectum is another often-used treatment. Nitroglycerin’s primary purpose is for angina, the chest pain that comes from blocked heart arteries.

DEAR DR. DONOHUE: Are there many types of Parkinson’s disease? I have been told that if your hands shake when you hold them up, it’s not Parkinson’s. It’s Parkinson’s only if they shake when they’re down. I’ve seen people who shake either way, and they have been diagnosed with Parkinson’s. — M.O.

ANSWER: Somehow, it’s gotten around that a tremor is an automatic sign of Parkinson’s. That’s not true. When it is present, most Parkinson’s patients have a hand tremor when their hands are at rest. The hands can be comfortably lying in the lap when the tremor is most observable. One common kind of tremor is the rolling of the index finger over the thumb.

Tremor is only one sign of this illness. Rigid muscles, slow movement, a tendency to fall, handwriting that becomes smaller and smaller, an expressionless face, diminished blinking and a walk that consists of tiny steps that speed up are other signs.

I have never heard of the upward versus downward hand tremor that is specific for Parkinson’s.

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. Readers may also order health newsletters from www.rbmamall.com.

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