Stewart reported an algorithm that can be used to screen a patient for mineralocorticoid-based hypertension. The author is from Queen Elizabeth Hospital in Birmingham, England.
Mineralocorticoids that may be associated with hypertension:
(1) aldosterone
(2) deoxycorticosterone
(3) cortisol (with 11-beta-hydroxysteroid dehydrogenase deficiency)
Patient selection - one or more of the following:
(1) severe hypertension (requiring multiple drugs for control)
(2) familial hypertension
(3) hypertension with hypokalemia
Parameters:
(1) plasma rennin concentration
(2) plasma aldosterone concentration
Plasma Renin
Plasma Aldosterone
Consider
high
NA
secondary aldosteronism
normal
consider non-mineralocorticoid cause
low
liquorice, Liddle's syndrome, apparent mineralocorticoid excess (AME), deoxycorticosterone excess
normal or high
primary aldosteronism
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Specialty: Endocrinology, Clinical Laboratory, Nephrology, Cardiology
