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Algorithm of Stewart for Evaluating a Patient with Possible Primary Hyperaldosteronism

Purpose: To evaluate a patient with clinical and biochemical findings suggestive of primary hyperaldosteronism using an algorithm by Stewart.

Description

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.

 

Differential diagnosis:

(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

Adrenal Mass

Consider (from List Above)

rise

normal

none or equivocal

1 (BAH)

rise

normal

> 1 cm mass

2 (ARAPA)

no rise or fall

elevated

> 1 cm mass

3 (APT)

no rise or fall

elevated

none or equivocal

4 (GSA)

 

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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Specialty

Objective

ICD-10