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Clinical chemistry
Adrenal Gland
Fludrocortisone suppression test
Author: Renu Virk, M.D. (see Authors page)
Revised:
Copyright: (c) 2002-2012, PathologyOutlines.com, Inc.
Indication
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● Confirms the diagnosis of primary (hyper)
aldosteronism
● One of four tests recommended for
screening or confirmation: also oral sodium loading, saline infusion and captopril
suppression (Horm
Metab Res 2010 Jan 29 [Epub ahead of print])
Rationale
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● Fludrocortisone suppresses aldosterone production in normal subjects (molecule is structurally similar to cortisone, Wikipedia), but not in patients with primary aldosteronism
Procedure
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● Correct hypokalemia if patient is hypokalemic before administering this test
●
Give fludrocortisone 0.2 mg twice daily with 500 mg NaCl supplementation for 3 days
(Scand J
Clin Lab Invest 2009;69:234)
● Measure urine aldosterone excretion on the third day
Normal reference
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● Levels should be < 10 g/d (28 nmol/d) in normal subjects
● Normal suppression excludes primary hyperaldosteronism
Adverse effects
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● May precipitate severe hypokalemia
● Serum potassium should be monitored regularly during the test
● Due to sodium loading, this test should not be used in the elderly and in patients with severe hypertension
● Test should be used with care and is not a first line screening test
Clinical - other
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●
Intravenous saline load test is a reasonably good alternative to this more
expensive and complex test to diagnose primary aldosteronism after a positive
screening test (J Clin Endocrinol Metab 2006;91:2618)
Additional references
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●
Leeds General Infirmary & Harrogate General Hospital
End of Clinical Chemistry > Adrenal Gland > Fludrocortisone suppression test
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