Primary Hyperadosteronism

Interesting case Conference 11/13/2008 Ashish Dhungel Susan Steigerwalt

Case ,[object Object],[object Object],[object Object]

[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object]

[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object]

Physical exam ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object]

Investigation ,[object Object],[object Object],[object Object]

Differential Diagnosis- young woman with stage 2 hypertension

Differential Diagnosis- young woman with stage 2 hypertension ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object]

Additional Evaluation? ,[object Object],[object Object],[object Object],[object Object],[object Object]

Guideline Approach to pt with suspected Primary Aldosteronism

[object Object],[object Object],Jerome W.Conn 09 /24/1907 –06/ 11 1981

Incidence ,[object Object],[object Object],[object Object],[object Object],[object Object]

Forms of PA ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object]

Clinical features ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object]

Aldosterone ,[object Object],[object Object],[object Object],[object Object],[object Object]

Hypertension in PA ,[object Object],[object Object],[object Object]

Hypokalemia in PA ,[object Object],[object Object],[object Object],[object Object]

Diagnosis Patients with HTN that are at risk of PA Case detection using ARR Case confirmation Adrenal CT AVS Subtype testing

Importance of case detection ,[object Object],[object Object],[object Object]

[object Object],[object Object],[object Object],[object Object]

Case detection ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object]

Aldosterone to Renin Ratio (AAR) ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object]

[object Object],[object Object]

Case Confirmation ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object]

Fludrocortisone suppression test

Subtype classification ,[object Object],[object Object],[object Object],[object Object],[object Object]

Limitation of CT ,[object Object],[object Object],[object Object]

[object Object],[object Object],[object Object],[object Object],[object Object]

AVS ,[object Object],[object Object],[object Object],[object Object],[object Object]

AVS Protocol ,[object Object],[object Object],[object Object],[object Object],[object Object]

Treatment ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object]

Treatment ,[object Object],[object Object],[object Object]

Spironolactone ,[object Object],[object Object]

GRA ,[object Object],[object Object],[object Object]

Back to our patient-wow! ,[object Object],[object Object],[object Object],1.17 26.7 315 IVC >4:1 53.51 236 12630 L adrenal vein 1.8 322 600 R adrenal vein L:R A/C ratio Cortisol corrected aldosterone ratio Cortisol Aldosterone Vein

Our patient ,[object Object],[object Object]

Primary Hyperadosteronism

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Primary Hyperadosteronism