Test for primary aldosteronism

#  hypertension and hypokalemia are controlled
#  avoiding spironolactone and eplerenone

A. Oral sodium loading
<<Oral sodium loading test>>
1. 抽Aldosterone and Renin activity
2. 請病人每天吃鹽6 g，吃兩天
3. 第三天開始留24-hr尿，檢測urine aldosterone, Na/K, Cr.
4. Urine aldosterone excretion >12 to 14 mcg/24 hrs-->確診
5. Urinary excretion of sodium >200 mEq/day-->adequet sample

B. Intravenous sodium loading test (ABAYSALIN)
<<Saline infusion test>>
1. 請病人平躺
2. stat 抽Aldosterone and Renin activity before N/S hydration
3. N/S 2L run 4hr
4. 抽 Aldosterone and renin activity after N/S hydration
5. On EKG monitor, check BP and HR Q15 mins during test
6. If patient complained of SOB, chest discomfort, headache, etc...
    ==> please call Dr to see if the test should be stoped.
7. test 後PAC >10 ng/dL --> 確診，PAC <5 ng/dL --> 排除

C. Captopril challenge test
<<Captopril challenge test>>
1. 請病人至少維持坐立或站立一小時再開始test，直到結束
2. Captopril 25–50 mg PO
3. 服藥後1hr, 2hr各抽一次PRA, Aldosterone, Cortisol
4. Aldosterone >15ng/dl --> 確診

The use of the fludrocortisone suppression test is limited
The captopril suppression test is less standardized alternative if sodium loading is
contraindicated as in heart or renal failure.