Brief Answer: Hyperaldosteronism Detailed Answer: Yes I agree with you that Primary Hyperaldosteronism must be ruled. However, it would be worthwhile evaluating for the possibility of Pheochromocytoma as well. The eosinophils I believe can be a part of your asthmatic tendency but check with your pulmonologist. It is not related to the hyperaldosteronism nor pheochromocytoma. The best screening test for hyperaldosteronism is ARR (Aldosterone Renin Ratio) which entails performing 2 blood tests and then calculating the ratio: PAC / PRA = Plasma Aldosterone Concentrations / Plasma Renin Activity. This test is ideally supposed to be done mid morning after ambulating for a couple hours, and then sitting upright for 5-15 minutes. Fasting is not necessary. Further, the potassium must be normalized before doing this test. Hence take your potassium supplements adequately and check potassium on the same sample. During the days prior to the test, liberalize your salt intake because this is important. But monitor your blood pressure closely to make sure it does not rise sharply due to salt intake. There are specific requirements for the time of the blood collection to ensure the red blood cells dont 'hemolyse' giving a falsely high potassium reading. Generally labs are familiar with ways to accomplish this such as no fist clenching, waiting 5 seconds after tourniquet release to draw blood from the veins etc. If this test is abnormal, confirmatory tests will need to be done. A good screening test for pheochromocytoma is to check plasma fractionated metanephrines.

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Brief Answer: Yes Detailed Answer: It would be ideal to have the 24 hour urine collection on the same day as the 'spell'. However a 24 hour urine collection can have logistical challenges on that day, but it can be achieved. The screening test in blood can be relatively easier to do. Pheochromocytoma typically has this episodic presentation, but Hypealdosteronism is not associated with 'spells'. It is important to meet proper test conditions for this and so it would be worth repeating the way I described above. Alternatively, if you are doing a 24 hour collection anyway then talk to your endocrinologist to see if he can arrange an 'Oral Salt Loading Test' which is a confirmatory 24 hour urine collection to measure aldosterone along with sodium and creatinine. It requires some preparation such as adequate salt intake amongst oother things.

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