Brief Answer:
First a renovascular disease should be excluded.

Detailed Answer:
Hello! Thank you for asking on HCM!

Regarding your concern I would explain that Aldosterone/PRA ratio is low when any of 2 components is abnormal; in your case high PRA counts for the low ratio result. One of the very first explanation for this view is renovascular disease. But we should be careful that all the three antihypertensive drugs you are using do influence the results. It is very important to follow a scrupulous scheduled regimen when performing this test. A more complete background of your blood analysis and MRI & CT scan is needed to specify the disorder (including electrolytes, liver function tests, etc). Please send them if possible.

Greetings! Dr. Iliri

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Brief Answer:
Some points to emphasise.

Detailed Answer:
Hello again Deborah! There are some points to emphasise:
a) Renal artery stenosis can be studied by: (1) vascular ultrasound; (2) angio CT or angio MRI of the renal arteries; (3) renal arteries angiography.
b) Facing your lab test results seem you have subclinical hypothyroidism (high TSH, normal free T4); I recommend you to consult an endocrinologist.
c) I am interested to know the conclusions of CT and MRI already performed. What is the prescribed opinion about the adrenal glands. If tumor is excluded, then what are those masses?!!! Bilateral hyperplasia?!! Anything else?!!
d) As I mentioned before I still insist on Aldosterone/PRA ratio test procedure. Besides other specificities to be followed, many drugs interfere with the results; thus contributing to false conclusions. All three medications you use affect Aldosterone/ PRA ratio. Did you switch off the antihypertensive therapy before performing lab tests? Also hypothyroidism (even subclinical) do affect Aldosterone / PRA ratio.
e) The last thing I would like to mention is to check the reason of elevated alkalin phosphatase (exclude from different options).
Hope to have been helpful to you! Greetings! Dr. Iliri

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Brief Answer:
There is need for imagine tests follow up.

Detailed Answer:
Hello again, dear Deborah! I reviewed you abdominal ultrasound and CT report.
(1) Regarding adrenal masses, seems that we have to do with the so called adrenal incidentalomas ( no adrenal hormonal alterations are confirmed by lab exams). There exists suspicion for adenomas, but many times CT scan or even MRI cannot differentiate precisely a specific etiology. When dealing with adrenal masses the main actions to perform are to exclude a primary adrenal cancer, or a metastatic development from elsewhere. From your performed exams there is a very low probability for a primary adrenal cancer. There isn't also any evidence of any primary tumors elsewhere in the abdomen (including bone structures and viscera, etc). If imagine exams do not conclude a final diagnosis many times a guided biopsy is helpful. Anyway, small mass dimensions and no hormonal alterations impose the need for follow ups with serial imagine tests (CT or MRI) to judge for changes in dimensions, or new appearing lesions.
(2) There exists concern about the elevated level of alkaline phosphatase. I recommend you to follow consequently the level of alkaline phosphatase and to exclude several reasons for elevated levels.
(3) Regarding that tiny hypo-density of the left kidney, it may be a banal cyst; no significant probability of renin-secreting tumor (as a high blood Aldosterone level would be evident as a consequence). Nevertheless, the same strategy would be recommendable as for the adrenal masses: to follow consequently any possible changes of these findings by using imagine tests (CT&/or MRI).
Hope to have been helpful to you. My Best Wishes!

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