| Primary Aldosteronism |
| |
- Challenge with sodium loading (10 gm/day) before measuring plasma
K+.
|
| |
- Repletion of K+ to normalize plasma K+ before
measuring plasma or urinary aldosterone.
|
| |
- Complete reliance on a postural aldosterone stimulation test (70%
accuracy).
|
| |
- Failure to measure cortisol during adrenal vein sampling of aldosterone
to validate correct positioning.
|
| |
- Failure to recognize bilateral adrenal hyperplasia.
|
| |
- Adrenal hemorrage during adrenal vein sampling.
|
| Cushing's Syndrome due to Adrenal Adenoma or Carcinoma |
| |
- Failure to identify the use of exogenous steroids causing Cushing's
Syndrome.
|
| |
- Inadequate physical examination essential for the diagnosis..
|
| |
- Knowledge that alcoholism and depression can mildly elevate plasma
cortisol (pseudo-Cushing's).
|
| |
- Inability to diagnose pituitary Cushing's by finding elevated
plasma ACTH (corticotrophin).
|
| Adrenal Carcinoma |
| |
- Evaluation for metastatic disease.
|
| Incidentaloma |
| |
- Metabolic evaluation to identify functional lesions.
|
| |
- MRI to determine tissue composition
|
| Pheochromocytoma |
| |
- Careful evaluation to reveal multiple lesions.
|
| |
- Measurement of urinary catecholes and metabolites even if plasma
catecholes are normal.
|
| |
- Evaluation for other components when Multiple Endocrine Abnormailty
(MEA) syndromes are suspected.
|