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Aldosterone

Baylor University
Uploaded: A month ago
Contributor: mazal24
Category: Medicine
Type: Outline
Rating: N/A
Filename:   Aldosterone.pptx (43.04 kB)
Page Count: 3
Credit Cost: 1
Views: 16
Last Download: N/A
Transcript
Aldosterone The most important test to establish a diagnosis of hyperaldosteronism or hypoaldosteronism is plasma aldosterone. Aldosterone can be measured in the plasma as the unmodified hormone, and in the urine as the 18-glucuronide conjugated metabolite of aldosterone. Screening for primary aldosteronism should include the determination of the ratio of plasma aldosterone concentration (PAC)/plasma renin activity (PRA), that is, the aldosterone to renin ratio (ARR). Aldosterone and renin concentrations are affected by numerous conditions and medication. Therefore, it is recommended that testing be performed under the following conditions: patients with normal potassium concentrations, patients with normal salt intake, patients removed from drugs that affect the ARR, and midmorning collection in patients who have been ambulatory for at least 2 hours. Cushing Syndrome Once Cushing syndrome is confirmed, a series of tests can then be performed to locate the cause of the hypercortisolism. Plasma ACTH testing should be performed to determine the etiology of the hypercortisolism. If ACTH is suppressed, an adrenal source is suspected. If ACTH is high or inappropriately normal, the patient may have a pituitary adenoma. If an ACTH-secreting pituitary adenoma is suspected, MRI of the pituitary gland to identify a mass or petrosal sinus blood sampling to collect samples coming directly out of the pituitary after CRH stimulation is used as a confirmation test. A ratio of petrosal ACTH to serum ACTH above suggested cutoff values before and after CRH administration is consistent with a pituitary cause. If the ACTH is suppressed, a CT of the adrenal glands is likely to be informative to identify an adrenal tumor and indicate an adrenal cause. If an ectopic ACTH-secreting tumor is suspected, this can be challenging to locate, but imaging studies are often valuable. Chest, pancreas, colon, and gall bladder carcinomas have been shown to be sources of cortisol secretion. INSTRUCTIONAL OBJECTIVES: Discuss and explain Cushing Syndrome and the laboratory analysis necessary to confirm the diagnosis Discuss and identify the etiology, hormone abnormality and laboratory studies needed to diagnosis the three (3) main variants of Cushing Syndrome: Cushing disease Adrenal Cushing syndrome Cushing syndrome from ectopic ACTH production

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