What is your preferred method for confirming the diagnosis of primary aldosteronism in a patient with an elevated plasma aldosterone to renin ratio?

The endocrine guidelines on primary aldo diagnosis (1) allow for 3 confirmatory tests: 24-hour urine, fludrocortisone suppression testing, and response to saline infusion. At UAB, we use the 24-hour urine collection. Most of our patients do not need additional salt loading during the 24-hour collect...

We do an oral salt suppression test. This is the protocol that we use. Hope it helps.

Day 1- Take sodium chloride tablets 2 g 3 times a day. Also, take a potassium chloride tablet 40 mEq twice a day. Continue to monitor BP daily.

Day 2- Take sodium chloride tablets 2 g 3 times a day. Take a potassiu...

We usually do not proceed with "confirmatory" testing for primary aldosteronism if there is a high probability of primary aldosteronism, especially lateralizing (suppressed renin and aldosterone >10 ng/dl). We use aldosterone suppressive tests in case of indeterminate results in order to get more in...