Comments on Precious Bodily Fluids: We've got one! Finding a functional adrenal adenom...

VA, Kaplan was how I learned about primary hyperal...

2011-12-10T23:37:06.492-05:00

VA, Kaplan was how I learned about primary hyperaldo. While studying for internal medicine recertification that went all sideways. Question 3 of the endocrine section has a 47 yr old women with a ARR of 230 that does not surpress with sodium loading. There are four options: Adrenalectomy, adrenal vein cath, CT scan, and duplex US.

I went with the cath and they wanted the CT based on the endocrine society's recs.

Hi Joel, Great case. We had one with aldo 51 and r...

2011-12-06T12:53:21.684-05:00

Hi Joel, Great case. We had one with aldo 51 and renin <0.4 with a nodule that turned out to be bilateral adrenal hyperplasia on AVS.

Interestingly, Kaplan in his textbook says to bypass the adrenal CT imaging and to go straight for AVS if found to have primary aldo.

Wow, what a great comment. What I'd like to p...

2011-12-06T11:20:07.120-05:00

Wow, what a great comment.

What I'd like to point out is that the ratio never was normal. The first aldo was high but we didn't have a renin to evaluate it.

The second ratio was 20 with a low aldo, so I considered that a negative but the Endocrine Society states that requiring an absolutely high aldo of 15 to 16 may not be necessary, though in that same paragraph they recommend a ARR of 30, not the 20 I use as a cut off.

I may start using the saline suppression test. I'll look into it.

Thanks for your great comment. Warms the heart.

Love your blog! I wonder why the PAC varied so mu...

2011-12-05T15:35:14.199-05:00

Love your blog! I wonder why the PAC varied so much over time? Makes me wonder about the people with hypokalemia that I have screened and gotten a normal ratio, I will now consider repeating. I do send people for the saline suppression - it takes a few hours at our infusion clinic, it's not hard. I've saved a few people a trip across the state to Ann Arbor for the vein sampling. They are very good there, but it's a long drive and an invasive procedure. I've had two patients with high ratios that suppressed nicely with saline. Anyway, I'm a huge fan, your blog is like a direct link to my nephrology id - I'm always thinking "Yes! So glad I'm not the only one!" Keep up the great work.
- Katie Kwon MD FASN
Lake Michigan Nephrology
St. Joseph MI