Stewart reported an algorithm that can be used evaluate a patient suspected of having primary aldosteronism. The author is from Queen Elizabeth Hospital in Birmingham, England.
Patient selection: hypertension with low plasma renin and normal to high plasma aldosterone levels
Initial evaluation: Postural study (supine for a period then upright) with measurement of plasma aldosterone and 11-beta-hydroxycorticosterone.
(1) bilateral adrenal hyperplasia (BAH)
(2) angiotensin-II-responsive aldosterone producing adenoma (ARAPA)
(3) aldosterone-producing tumor (APT)
(4) glucocorticoid-suppressible hyperaldosteronism (GSA)
Change in Aldosterone
Change in 11-beta-OH-C
Consider (from List Above)
none or equivocal
> 1 cm mass
no rise or fall
Glucocorticoid-suppressible hyperaldosteronism can be confirmed by:
(1) corticotropin stimulation test
(2) dexamethasone suppression test
(3) adrenal vein catheterization with blood sampling
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Purpose: To evaluate a patient with clinical and biochemical findings suggestive of primary hyperaldosteronism using an algorithm by Stewart.
Specialty: Endocrinology, Clinical Laboratory
Objective: clinical diagnosis, including family history for genetics, criteria for diagnosis