Diagnosis
4
Figure 1. Algorithm for the Detection, Confirmation,
Subtype Testing, and Treatment of PA
Patients with Hypertension that are at Increased Risk for PA
Treat with MR Antagonist
(1|⊕⊕⊕
)
Confirmatory Testing (1|⊕⊕
)
a
ES recommends unilateral laparoscopic adrenalectomy for patients with documented unilateral
PA (ie, APA or 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, ES similarly recommends medical
treatment including an MR antagonist (1|⊕⊕
).
b
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, undetectable renin,
and PAC >20 ng/dL (550 pmol/L), ES suggests that there may be no need for further confirmatory
testing (2|⊕
).
c
ES recommends that when surgical treatment is feasible and desired by the patient, an experienced
radiologist should use AVS to make the distinction between unilateral and bilateral adrenal disease
(1|⊕⊕⊕
). Younger patients (20 ng/dL
ARR to Detect Cases (1|⊕⊕
)
Subtype
Testing
