Adding the evaluation of Cushing's to the schema for PA. Seems like it should be added esp if there is an adrenal bump. or bumps.

[Guest guest]

As our discussions of cortisol production have been stimulated by the

NIH experience I did a lit search and just found

http://www.jabfm.org/content/25/2/199.full.pdf+html

This article on subclinical Cushing's suggests that we need to add the

screening for CS to all with an adrenal adenoma or any suggestion of

Cushig's: HTN,obesity, glucose intolearance etc etc.

In other words everyone with HTN should be screened.

So in my protocol for easy diagnosis I am adding to the 24 hr urine a

urinary free cortisol testing-which have have done in many but never

found (or at last recognized) a subclinical Cushing's. These authors

suggest that a UFC at the upper limit of normal should have further

testing for Cushing's. Again I have never seen this in at least 100

pts with Conn's I have tested over the years. But did not have ACTH

levels then.

It seems like we should also add a plasma cortisol and ACTH to the

blood testing on the aldo day.

They do not suggest doing a P aldo or a renin in every suspected

Cushing's but I just sent them an email adding this to their schema if

the BP is above 120/80.

If one looks at the evolution of PA the evolution of adrenal Cushing's

would be similar using urinary cortisol as the illustrative plot for

urine changes in cortisol and the stages of Cushings would be the same

as I have for Conn's but the instead of renin going down we would be

seeing ACTH going down and obesity/glucose intolerance increasing over

time.

More later.

CE Grim MD