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Tests and diagnosis
By Mayo Clinic staffIf the aldosterone-renin test suggests that you might have primary aldosteronism, you'll need another test to confirm the diagnosis, such as one of the following:
- Oral salt loading. You'll follow a high-sodium diet for three days before your doctor measures aldosterone and sodium levels in your urine.
- Saline loading. Your aldosterone levels are tested after sodium mixed with water (saline) is infused into your bloodstream for several hours.
- Fludrocortisone suppression test (FST). After you've followed a high-sodium diet and taken fludrocortisone — which mimics the action of aldosterone — for three days, aldosterone levels in your blood are measured.
Additional tests
If you receive a diagnosis of primary aldosteronism, your doctor will run additional tests to determine whether the underlying cause is an aldosteronoma or overactive adrenal glands. Tests may include:
- Abdominal computerized tomography (CT) scan. A CT scan can help identify a tumor on your adrenal gland or an enlargement that suggests overactivity. You may still need additional testing after a CT scan because this imaging test may miss small but important abnormalities or find tumors that don't produce aldosterone.
- Adrenal vein sampling. This is the most reliable test for determining the cause of primary aldosteronism. A radiologist draws blood from both your right and left adrenal veins and compares the two samples. Aldosterone levels that are significantly higher on one side indicate the presence of an aldosteronoma on that side. Aldosterone levels that are similar on both sides point to overactivity in both glands. Though essential for determining the appropriate treatment, this test increases your risk of a blood clot at the site where the blood is drawn.
- Funder JW, et al. Case detection, diagnosis and treatment of patients with primary aldosteronism: An Endocrine Society clinical practice guideline. Journal of Clinical Endocrinology & Metabolism. 2008;(93):3266-3281.
- Gomez-Sanchez CE, et al. Three perspectives on aldosterone's role in cardiovascular disease: Salt's not the only bad guy. The Endocrine Society. http://www.endo-society.org/endo_news/tri_point/upload/Tri-Point-Series-June-2005-EN.pdf. Accessed Sept. 25, 2008.
- Young WF, et al. Clinical features of primary aldosteronism. http://www.uptodate.com/home/index.html. Accessed Sept. 25, 2008.
- Hyperaldosteronism. The Merck Manuals Online Medical Library: The Merck Manual for Healthcare Professionals. http://www.merck.com/mmpe/sec12/ch153/ch153f.html. Accessed Sept. 25, 2008.
- Sechi LA. Long-term renal outcomes in patients with primary aldosteronism. Journal of the American Medical Association. 2006;295(22):2638-2645.
- Young WF, et al. Treatment of primary aldosteronism. http://www.uptodate.com/home/index.html. Accessed Sept. 25, 2008.
- Aldosterone and renin. Lab Tests Online. http://www.labtestsonline.org/understanding/analytes/aldosterone/test.html. Accessed Sept. 28, 2008.
- Young WF, et al. Clinical features of primary aldosteronism. http://www.uptodate.com/online/content/topic.do?topicKey=adrenal/19130&selectedTitle=3~56&source=search_result. Accessed Nov. 28, 2008.
- Young WF, et al. Treatment of primary aldosteronism. http://www.uptodate.com/online/content/topic.do?topicKey=adrenal/19430&selectedTitle=2~56&source=search_result. Accessed Nov. 28, 2008.
