Diagnosis
12
Captopril challenge test
Patients receive 25–50 mg of captopril orally
after sitting or standing for at least 1 h. Blood
samples are drawn for measurement of PRA,
plasma aldosterone, and cortisol at time zero
and at 1 or 2 h after challenge, with the patient
remaining seated during this period.
Plasma aldosterone is normally
suppressed by captopril (>30%). In
patients with PA it remains elevated and
PRA remains suppressed. Differences
may be seen between patients with
APA and those with IAH, in that
some decrease of aldosterone levels is
occasionally seen in IAH.
Adapted from J. W. Funder et al: Case detection, diagnosis, and treatment of patients with primary
aldosteronism: an Endocrine Society Clinical Practice Guideline. J Clin Endocrinol Metab.
2008;93:3266 –3281, with permission. © Endocrine Society.
Table 6. PA Confirmatory Tests (cont'd)
Test and Procedure Interpretation
Î ES recommends unilateral laparoscopic adrenalectomy for patients
with documented unilateral PA (ie, aldosterone-producing adenoma
[APA] or unilateral adrenal hyperplasia [UAH]) (1|⊕⊕⊕
). If a patient
is unable or unwilling to undergo surgery, ES recommends medical
treatment including a MR antagonist (1|⊕⊕⊕
). If an ARR-positive
patient is unwilling or unable to undergo further investigations, we
similarly recommend medical treatment including an MR antagonist.
(1|⊕⊕
)
Î In patients with PA due to bilateral adrenal disease, ES recommends
medical treatment with an MR antagonist (1|⊕⊕
). ES suggests
spironolactone as the primary agent, with eplerenone as an alternative
(Figure 1). (2|⊕
)
Î In patients with GRA, ES recommends administering the lowest dose
of glucocorticoid to lower ACTH and thus normalize BP and potassium
levels as the first-line treatment (Figure 1) (1|⊕
).
• In addition, if BP fails to normalize with glucocorticoid alone, an MR antagonist
may be added. For children, the glucocorticoid dosage should be adjusted for age
and body weight, and BP targets should be determined from age- and gender-
specific published normative data.
Treatment
