Subjective
Date of visit
Reason for visit (follow-up for primary aldosteronism, evaluation of new symptoms)
Current symptoms:
Headache (may be severe and frontal)
Weakness
Muscle cramps
Difficulty controlling blood pressure (hypertension)
Palpitations
Polyuria and polydipsia (excessive urination and thirst)
Hypokalemia symptoms (muscle weakness, fatigue, arrhythmias) – due to excessive potassium excretion
Recent changes in medications or health
Stressful events since last visit
Objective
Vital signs (temperature, blood pressure, heart rate, weight) – elevated blood pressure is a hallmark finding
Physical exam:
General (assessing for fluid overload, signs of heart failure)
Fundoscopic exam (checking for retinal changes from hypertension)
Neurological exam (brief exam to assess for muscle weakness)
Laboratory Tests
Electrolytes:
Serum potassium (may be low)
Serum sodium (may be high)
Blood pressure measurements (sitting and standing)
Plasma renin activity (PRA): typically suppressed in primary aldosteronism
Aldosterone concentration: elevated in primary aldosteronism
Aldosterone-to-Renin Ratio (ARR): elevated in primary aldosteronism
Creatinine level (to assess kidney function)
Imaging Tests (may be ordered depending on workup):
Adrenal CT scan or MRI scan: to identify adrenal tumors (possible cause of primary aldosteronism)
Assessment
Primary aldosteronism confirmed (based on clinical presentation, laboratory findings)
Blood pressure control (adequate or not)
Presence of any complications from hypertension or electrolyte imbalances
Evaluation for subtype of primary aldosteronism (adrenal adenoma, bilateral adrenal hyperplasia) – imaging studies may help differentiate
Plan
Treatment plan based on severity of symptoms and subtype of primary aldosteronism:
Blood pressure medications (antihypertensives) – calcium channel blockers, angiotensin receptor blockers (ARBs) are preferred choices
Potassium-sparing diuretics (to correct hypokalemia) – only if appropriate for blood pressure control
Mineralocorticoid receptor antagonists (spironolactone) – may be used for specific subtypes
Surgical adrenalectomy (removal of adrenal adenoma) – may be an option for unilateral adenoma
Monitoring of electrolytes and blood pressure
Education
Explain primary aldosteronism, its causes, and potential complications (hypertension, heart disease).
Discuss the importance of medication adherence and following a healthy lifestyle (diet, exercise).
Importance of monitoring blood pressure at home.
Review signs and symptoms of worsening condition (worsening headache, vision changes) that may require urgent medical attention.
Follow-up
Schedule for follow-up appointments:
Monitor response to treatment (blood pressure control, electrolyte levels)
Adjust medication regimen as needed
Address any ongoing challenges or concerns
Disclaimer: This information is for educational purposes only and should not be interpreted as medical advice. Please consult with a qualified healthcare professional for diagnosis and treatment of primary aldosteronism