It involves sampling the blood in both of your adrenal veins via a large guidewire directed catheter and comparing the level of aldosterone on the right and lefts sides. If the tumor cannot be localized to either the right or left side, it is presumed that you have bilateral adrenal hyperplasia.
There is no role for needle biopsy and it is contraindicated. Unilateral adrenal nodules that cause primary hyperaldosteronism are treated with a laparoscopic adrenalectomy. This is a minimally invasive procedure that will remove the tumor that is over-producing aldosterone hormone, allowing your body to return back to its normal state. Bilateral Adrenal Hyperplasia is treated with medication that includes aldosterone-antagonist drugs and a low salt diet.
Patients treated with medication for bilateral adrenal hyperplasia can achieve stabilization of potassium levels once properly controlled, but generally remain on multiple hypertensive medications to control their blood pressure. Patients should be regularly followed by their endocrinologist. Even patients that have a successful adrenalectomy should have yearly blood tests to monitor potassium, aldosterone, and renin levels. They are able to come off all blood pressure medications.
These are usually younger patients with a shorter course of the disease. If you are an ALDO slam dunk, in a way, congratulations. Note, we do not take it lightly that you have a disease, but this is fixable! You do not need to undergo any more confirmatory testing. You can move 2 steps ahead straight to an adrenal-protocol CT scan if you cannot tolerate intravenous contrast, you can have an adrenal-protocol MRI. You may not need to have the adrenal vein sampling, but rather move 2 additional steps ahead straight to what will likely be a curative adrenalectomy.
All patients who are diagnosed accurately with unilateral primary hyperaldosteronism benefit from surgery, but women, and young patients tend to benefit the most. Yes, the operation will prevent you from developing future strokes, heart attacks, and arrhythmias for instance, atrial fibrillation , and premature death.
Do not worry about this. Carling is used to evaluating laboratory data from around the world and can easily make sense of this. It is helpful, though, to include the reference range of any assay from the laboratory when you send us your data. The first confirmatory test you should have done is to repeat the aldosterone to renin ratio ARR as it is the most reliable screening test for primary hyperaldosteronism.
Again, screening is easy. Ask our doctor via a simple blood test to check your plasma aldosterone concentration PAC and plasma renin activity PRA. Remember, The classic way to diagnose primary hyperaldosteronism due to an adrenal tumor making too much aldosterone is the PRA:. Borderline Cases Not Quite Sure? The Endocrine Society based out of the United States guidelines recommend that patients with borderline equivocal ARR, and plasma aldosterone concentration PAC should undergo a confirmatory test to definitively confirm or exclude the diagnosis of primary hyperaldosteronism.
One of the issues are that the medical endocrinology and medical nephrology experts have had difficulties in identifying what is the ideal confirmatory test. The Carling Adrenal Center recommends that you have a hour urine collection of your aldosterone level. If this level is in the high upper normal range or frankly elevated, this proves that you have primary hyperaldosteronism. However, the following somewhat cumbersome test have been advocated by some.
These tests are very rarely needed these days and most doctors would not use these outdated tests: Oral sodium loading test Intravenous saline loading test Fludrocortisone suppression test Captopril challenge test If your doctor is ordering any of these tests, please have them call Dr.
Carling so we can help. These tests are not reliable and are a huge pain in the butt for the patient and the doctors. CT scans from 4 different patients all with a left aldosterone-producing tumor arrows causing primary hyperaldosteronism. Based on the characteristics of the genetic alteration, patient, and CT scan characteristics, predictions can be made whether the patient can go straight to surgery or need adrenal vein sampling.
Once the confirmatory test proved that the diagnosis of primary hyperaldosteronism is accurate you may move ahead to the next step: adrenal imaging with an adrenal-protocol CT scan if you cannot tolerate intravenous contrast, you can have an adrenal-protocol MRI. We have an entire section of this large website on scans and x-rays for adrenal tumors. Read about adrenal X-rays and scans. In many cases, Dr. Carling can predict where the excess aldosterone is coming from based on the CT scan.
In fact, he has published extensively about this topic. Based on a combination of laboratory studies, the patient characteristics, genetic changes occuring in an aldosteronoma, and the findings on a CT scan, he can predict which patients can go straight to surgery versus the ones that will need more studies i.
Maybe, but many patients do not. Adrenal vein sampling AVS is sometimes needed to distinguish unilateral from bilateral adrenal sources of aldosterone secretion. This is an interventional radiology study. AVS should be performed in all patients with a CT scan that is questionaable or demonstrates adrenal tumors on both the right and the left side.
Through small catheters blood samples are obtained from each adrenal vein and the inferior vena cava sequentially, or simultaneously. Technical success is directly associated with operator experience. You need the best radiologist to do this study! There was no operative mortality. Postoperatively, normokalaemia was established in all patients.
Persistent postoperative hypertension was present in Conclusions: In our experience, Conn's syndrome could be diagnosed accurately with simple investigations and CT imaging of the adrenal glands.
Extensive biochemical testing, including aldosterone and PRA assay, is helpful when the diagnosis is uncertain.
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