Evaluation of plasma aldosterone to plasma renin activity ratio in patients with primary aldosteronism

Abstract

The plasma aldosterone to renin activity ratio (A/PRA) ratios in patients with primary aldosteronism were associated with unsuppressed plasma renin activity (PRA). was assessed retrospectively in 103 patients with primary aldosteronism including 74 patients with surgiAlthough the mean values of the A/PRA ratio differed significantly between the groups, complete separation cally proven adrenal cortical adenoma (APA) and 29 patients with idiopathic adrenal cortical hyperplasia was not obtained. The serum potassium level at time of testing did not influence the diagnostic value of the (IHA). The results were compared with those obtained in 31 patients with essential hypertension (EH) and 45 A/PRA ratio, although an inverse correlation between serum potassium and the A/PRA ratio was found in the healthy normotensive controls. The upper limit of normal A/PRA ratio, as obtained in the controls was 17.8. patients with APA. This study supports the high sensitivity of the A/PRA ratio in diagnosis of primary aldosThis value was exceeded in 89% of patients with APA; postoperatively it decreased in 97% of the APA group, teronism, however, a single determination with a normal result may not be sufficient for exclusion of the disease. and returned to normal in 81%. In the IHA group the A/PRA was elevated in 70% of patients. The normal

Is aldosterone the missing link in refractory hypertension?: aldosterone-to-renin ratio as a marker of inappropriate aldosterone activity

“…Furthermore, aldosterone production in Conn's adenoma in vivo relates to corticotropin secretion and this fact could question the 'autonomous' nature of aldosterone secretion which would explain why plasma aldosterone may not always be persistently elevated in some patients with APA. 14 …”

“…7 This explains the preponderance of PA cases due to Conn's adenoma by two-thirds to three-quarters over and above that of IHA in most PA series prior to the introduction of ARR as a screening test. 6,[13][14][15][16] However, with the shift in PA definition to that of assessing the lack of aldosterone suppressibility, IHA is more readily diagnosed and the use of ARR 7,17,18 as a screening tool has precipitated this. In fact, hypertensive patients with poorly suppressible aldosterone secretion in response to salt loading were described nearly three decades ago.…”

Familial hyperaldosteronism

“…The validity of screening for primary aldosteronism with the ARR, performed under random conditions with respect to salt intake is now well documented (28)(29)(30). However, there is no consensus regarding the indications for screening among hypertensives which takes into account recent reports of increased prevalence of primary aldosteronism using the ARR.…”

NP‐59 SPECT/CT Imaging in Stage 1 Hypertensive and Atypical Primary Aldosteronism: A 5‐Year Retrospective Analysis of Clinicolaboratory and Imaging Features

“…Patients with normotensive and subclinical PA may represent as an early, milder form of PA which may subsequently develop into hypertension on followup and lead to more aldosterone-dependent cardiovascular morbidity than essential hypertension [7, 8, 10]. Emerging evidence also has shown that PA patients may vary widely in their clinicolaboratory features [5], including atypical triad of normal PAC [6, 11–14], nonsuppressed PRA [6, 11], and normal ARR [6, 11]. In addition, significant numbers of prehypertensive PA may have a subclinical picture [8, 9].…”

“…In addition, significant numbers of prehypertensive PA may have a subclinical picture [8, 9]. Moreover, low-renin hypertension and PA may also share elevated ARR [11, 13]. Thus, detection of the early or milder form of PA represents a particular challenge for clinicians.…”