13
Physical Examination Screening Tests
Additional/
Confirmatory Tests
Abdominal mass
(polycystic kidney disease);
skin pallor
Renal ultrasound Tests to evaluate cause of
renal disease
Abdominal systolic-
diastolic bruit; bruits over
other arteries (carotid
– atherosclerotic or
fibromuscular dysplasia),
femoral
Renal Duplex Doppler
ultrasound; magnetic
resonance arteriography
(MRA); abdominal
computed tomography
(CT)
Bilateral selective renal
intra-arterial angiography
Arrhythmias (with
hypokalemia); especially
atrial fibrillation
Plasma aldosterone/renin
ratio under standardized
conditions (correction
of hypokalemia and
withdrawal of aldosterone
antagonists for 4–6 wk)
Oral sodium loading
test (with 24-h urine
aldosterone) or IV saline
infusion test with plasma
aldosterone at 4 h of
infusion;
Adrenal CT scan, adrenal
vein sampling.
Obesity; Mallampati class
III–IV; loss of normal
nocturnal BP fall
Berlin Questionnaire;
Epworth Sleepiness Score;
overnight oximetry
Polysomnography
Fine tremor, tachycardia;
sweating (cocaine,
ephedrine, MAO
inhibitors); acute
abdominal pain (cocaine)
Urinary drug screen (illicit
drugs)
Response to withdrawal of
suspected agent
Skin stigmata of
neurofibromatosis (café-au-
lait spots, neurofibromas);
Orthostatic hypotension
24-h urinary fractionated
metanephrines or plasma
metanephrines under
standard conditions
(supine position with
indwelling IV cannula)
CT or magnetic resonance
imaging (MRI) scan of
abdomen/pelvis
Central obesity;
"moon" face, dorsal and
supraclavicular fat pads,
wide (1-cm) violaceous
striae, hirsutism
Overnight 1-mg
dexamethasone suppression
test
24-h urinary free cortisol
excretion (preferably
multiple); midnight
salivary cortisol
