3
Î ES recommends using the plasma aldosterone/renin ratio (ARR) to
detect possible cases of PA in these patient groups. (1|⊕⊕⊕
)
Î Instead of proceeding directly to subtype classification, ES recommends
that patients with a positive ARR undergo one or more confirmatory
tests to definitively confirm or exclude the diagnosis (1|⊕⊕
).
However, in the setting of spontaneous hypokalemia, plasma renin
below detection levels plus plasma aldosterone concentration (PAC)
>20 ng/dL (550 pmol/L), ES suggets that there is no need for further
confirmatory testing. (2|⊕
)
Î ES recommends that all patients with PA undergo adrenal computed
tomography (CT) as in the initial study in subtype testing to exclude
large masses that may represent adrenocortical carcinoma and to
assist the interventional radiologist and surgeon where anatomically
appropriate (Figure 1). (1|⊕⊕⊕
)
Î ES recommends that when surgical treatment is feasible and desired
by the patient, an experienced radiologist should use adrenal
venous sampling (AVS) to make the distinction between unilateral
and bilateral adrenal disease (1|⊕⊕⊕
). Younger patients (
