Sarah Hughes is a 45-year old woman with new onset hypertension 180/110. Her blood pressure remains elevated despite the use of three antihypertensive agents.
List 5 lifestyle questions you would ask her.
- Salt intake
- Alcohol intake
- Caffeine
- Smoking adherence to medications
- Licorice ingestion
- Use of NSAIDS
- Cocaine
- Amphetamines
- Cold medications
- Oral contraception
Her potassium is low at 2.8 mmol/L, and you suspect hyperaldosteronism. How do you screen for hyperaldosteronism? How would you confirm the diagnosis of primary hyperaldosteronism?
Screen:
- Elevated serum aldosterone (>400 nmol/L);
- Elevated ratio of aldosterone:renin >140 (100-140 “grey zone”) (using renin measured as mass not activity, beware of units!)
Confirm with saline suppression test: 2 L saline infused IV over 4 hours, plasma aldosterone afterwards elevated >280 nmol/L
CT image (hyperplasia vs adenoma)
Adrenal vein sampling if image is confusing, or patient is >45 years old
