98-3-13-A Case Presentation

HTN

Hypokalemia

High ARR

Bilateral Adrenal masses (3cm, high HU, Low washout, heterogeneous)

High Cortisol level

Suppressed ACTH

The Management of Primary Aldosteronism: Case Detection, Diagnosis, and Treatment: An Endocrine Society Clinical Practice Guideline
John  W. Funder  (chair), Robert  M. Carey, Franco Mantero,  M. Hassan  Murad, Martin  Reincke, Hirotaka  Shibata,  Michael Stowasser,  and  William F. Young.  Jr
J Clin Endocrinol Metab, 2016

Groups with high prevalence of primary aldosteronism:

Resistant hypertension:

    Defined as SBP more than 140 mmHg and DBP more than 90 mmHg despite  treatment with three  hypertensive medications .

Hypertensive patients  with spontaneous or diuretic-induced hypokalemia

Hypertension with adrenal incidentaloma

Hypertension with obstructive sleep apnea

Quantitative Value of Aldosterone-Renin Ratio for Detection of Aldosterone-Producing Adenoma: The Aldosterone-Renin Ratio for Primary Aldosteronism (AQUARR) Study
Giuseppe Maiolino, MD; Giacomo Rossitto, MD; Valeria Bisogni, MD; Maurizio Cesari, MD; Teresa Maria Seccia, MD; Mario Plebani, MD; Gian Paolo Rossi, MD, FACC, FAHA; For the PAPY Study Investigators*, J Am Heart Assoc. 2017

The study entailed 2 large cohorts of referred prospectively recruited hypertensive patients, all of which underwent measurement of the ARR at baseline and after the captopril challenge test.

white patients 

between January 2012 and February 2015

recently diagnosed with hypertension

a longer (4 weeks) minimum wash-out period  (for  diuretics,  beta-blockers,  angiotensin-converting enzyme inhibitors, and angiotensin  II receptor type 1 antagonists)