Aldosteronism Screening and Diagnosis

In this talk, Dr. Holmes discusses the critical role the lab plays in case-finding and diagnosis of primary aldosteronism (PA). He also reviews the challenges that immunoassays have created in clearly defining PA with respect to confirmatory (salt loading) test thresholds. The value of mass spectrometry is also highlighted in terms of the identification of rarer conditions and the avoidance of GFR-related interferences plaguing immunoassays. The technical challenges of adrenal venous sampling for tumor localization are covered in addition to the invaluable role the lab can play in mitigating these challenges so that PA cases caused by adrenal adenoma can be clearly identified and potentially cured.
After viewing this lecture, participants should be able to:
1. Describe the clinical presentation of primary aldosteronism and describe which diagnostic tests are used to establish the diagnosis.
2. Identify the clinical contexts in which immunoassays will give inaccurate test results.
3. List two rare diagnoses that can be made serendipitously when tandem mass spectrometry is used for primary aldosteronism screening.
4. Discuss the technical challenges of adrenal venous sampling and how the laboratorian can mitigate these.
Dan Holmes, MD, FRCPC, division head, Clinical Chemistry, Assistant Department Head, St. Paul's Hospital Department of Pathology and Laboratory Medicine
10/25/17
depts.washingto...
uwtv.org

[@daphnekivinen9482]

I have a cheerio-size adenoma on each adrenal gland. I am on 50 mg. Eplerenone and 50 mg. Metoprolol. 2 BP readings 199/100 and 178/77. I am having adrenal vein sampling test on June 24. Heavy perspiration, extreme anxiety, fatigue, weakness are symptoms.

[@speaktruth9313]

How did the vein sampling test go?….Because of the sweating , ask about screening for a pheochromocytoma type adrenal tumor

[@jeffreyconnor9769]

Are you going to get surgery?

[@daphnekivinen9482]

@@jeffreyconnor9769 That was 3 years ago. I can't have surgery because after the vein sampling test, they found out both glands are secreting equal amounts of aldosterone. One has to be greater than the other before surgery can be performed. Thankfully my medications are working and keeping my BP at a normal range. My doctor did add Losartin, another BP med. The extreme perspiration isn't as bad until the weather has a lot of humidity. I do have a lot of anxiety, but if it gets real bad, I take generic xanax. I am very pleased that my condition is in control by the meds I take. Thank you for asking.

[@faerae9525]

C see

[@cameriqueTV]

Dr.'s in Des Moines aren't this smart.

[@daphnekivinen9482]

My diagnosis started from my PA checking a urine specimen for increased hormone "metanepherine". Good luck!