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🧪 Investigations for Primary Hyperaldosteronism: Laboratory and Imaging Primary hyperaldosteronism (PA), also known as Conn’s syndrome, is a common cause of secondary hypertension due to autonomous aldosterone production. Accurate diagnosis involves a stepwise approach using both laboratory and imaging studies to confirm the condition and determine its cause. 🧬 Laboratory Investigations These tests help screen for PA, confirm autonomous aldosterone secretion, and assess subtype classification. 🔹 Screening Tests Test Purpose Plasma Aldosterone Concentration (PAC) Elevated in PA Plasma Renin Activity (PRA) Suppressed in PA Aldosterone-to-Renin Ratio (ARR) Most sensitive screening tool 📌 A high ARR (e.g., Greater than 20–30) with PAC Greater than 15 ng/dL is suggestive of PA2. 🔹 Confirmatory Tests Test Description Interpretation Saline Infusion Test IV saline over 4 hrs; measure PAC PAC Greater than 10 ng/dL confirms PA Oral Salt Loading Test High sodium intake for 3 days; measure urinary aldosterone Greater than 12 µg/day supports PA Fludrocortisone Suppression Test 4-day protocol with salt and fludrocortisone Lack of aldosterone suppression confirms PA Captopril Challenge Test Measure PAC/PRA before and after captopril PAC remains elevated in PA ⚠️ These tests assess aldosterone autonomy—failure to suppress aldosterone confirms PA. 🖼️ Imaging Investigations Imaging is used after biochemical confirmation to localize the source of aldosterone excess. 🔹 Adrenal CT Scan Thin-slice contrast-enhanced CT is the first-line imaging modality. Detects adrenal adenomas or hyperplasia. May miss small lesions or misidentify incidentalomas5. 🔹 Adrenal Venous Sampling (AVS) Gold standard for subtype classification. Differentiates unilateral adenoma (surgical candidate) from bilateral hyperplasia (medical management). Measures aldosterone-to-cortisol ratio from each adrenal vein. 🧠 AVS is essential when surgery is considered, especially if CT findings are inconclusive 🔹 MRI and Nuclear Imaging MRI is comparable to CT but less commonly used. NP-59 scintigraphy (iodocholesterol scan) is rarely used today. 🩺 When to Screen for PA Consider testing in patients with: Resistant hypertension Hypokalemia Adrenal incidentaloma Early-onset hypertension or stroke Family history of PA #Hyperaldosteronism