Discontinue or avoid use Systemic corticosteroids (eg, dexamethasone, fludrocortisone, methylprednisolone, prednisone, prednisolone) Avoid or limit use when possible Consider alternative modes of administration (eg, inhaled, topical) when feasible Angiogenesis inhibitor (eg, bevacizumab) and tyrosine kinase inhibitors (eg, sunitinib, sorafenib) Initiate or intensify antihypertensive therapy *List is not all inclusive. ADHD indicates attention-deficit/hyperactivity disorder; BP, blood pressure; CVD, cardiovascular disease; IUD, intra-uterine device; MAOI, monoamine-oxidase inhibitors; MDPV, methylenedioxypyrovalerone; NSAIDs, nonsteroidal anti-inflammatory drugs; SNRI, serotonin norepinephrine reuptake inhibitor; SSRI, selective serotonin reuptake inhibitor; and TCA, tricyclic antidepressant. The most commonly used cutoff value is 30 when plasma aldosterone concentration is re- ported in nanograms per deciliter (ng/dL) and plasma re- nin activity in nanograms per milliliter per hour (ng/mL/ Because the aldosterone:renin activity ratio can be influenced by the presence of very low renin levels, the plasma aldosterone concentration should be at least 10 ng/dL to interpret the test as positive.S5.4.2-3 Patients should have unrestricted salt intake, serum potassium in the normal range, and mineralocorticoid receptor antago- nists (eg, spironolactone or eplerenone) withdrawn for at least 4 weeks before testing.S5.4.2-2,S5.4.2-3 3. The diagnosis of primary aldosteronism generally re- quires a confirmatory test (intravenous saline suppression test or oral salt-loading test).S5.4.2-2,S5.4.2-3 If the diagnosis of primary aldosteronism is confirmed (and the patient agrees that surgery would be desirable), the patient is re- ferred for an adrenal venous sampling procedure to de- termine whether the increased aldosterone production is unilateral or bilateral in origin. 