Urinary tetrahydroaldosterone as a screening method for primary aldosteronism: a comparative study

Abdelhamid, S.; Blomer, R; Hommel, Gerhard; Haack, D.; Lewicka, Sabina; Fiegel, P.; Krumme, B.

doi:10.1016/s0895-7061(03)00858-6

Cited by 50 publications

(46 citation statements)

References 24 publications

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“…Also, Ulick et al did not find a significant difference between essential hypertension and primary aldosteronism when measuring urinary tetrahydroaldosterone (35). Contrary to these findings, Abdelhamid et al reported a sensitivity and specificity of 95% and 96% for tetrahydroaldosterone and 91% and 71%, respectively, for aldosterone-18-glucuronide (22) in a large study population of 1865 patients using the same assay as in our study. Evaluation of the data differs in that Abdelhamid's group calculated the metabolite concentration as mg/day whereas we expressed the excretion per gram of creatinine in order to correct collection errors.…”

Section: Discussioncontrasting

confidence: 86%

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Confirmatory testing in normokalaemic primary aldosteronism: the value of the saline infusion test and urinary aldosterone metabolites

Schirpenbach¹,

Seiler²,

Maser-Gluth³

et al. 2006

eur j endocrinol

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Objective: Primary aldosteronism has recently been recognized as the most frequent cause of secondary hypertension. Since most patients are normokalaemic, differentiation to essential hypertension is challenging. As differentiation by baseline aldosterone/renin ratio may be insufficient, diagnosis should be confirmed by additional tests. However, as most confirmatory tests have been evaluated in hypokalaemic primary aldosteronism only, we reassessed the value of the saline infusion test and 24 h urinary aldosterone metabolites as confirmatory tests for both normo-and hypokalaemic primary aldosteronism under current antihypertensive medication. Patients and methods: 25 patients with primary aldosteronism (11 hypokalaemic, 14 normokalaemic), 29 patients with essential hypertension and 47 normotensive subjects were studied. The hypertensives received their usual medication with the exception of spironolactone. All subjects underwent a standard saline infusion test (determination of plasma aldosterone before and after 2.0 liters of isotonic saline for 4 hours i.v.) and collected a 24 h urine sample for examination of urinary tetrahydroaldosterone and aldosterone-18-glucuronide. Results: In hypokalaemic primary aldosteronism the saline infusion test showed a reasonable sensitivity (91%) and specificity (90%). However, the test failed to differentiate sufficiently between essential hypertension and normokalaemic primary aldosteronism (sensitivity 57%, specificity 90%). Similarly, urinary tetrahydroaldosterone had higher sensitivity in hypokalaemic than in normokalaemic primary aldosteronism (sensitivity 64% vs 36%, specificity 100%), whereas for aldosterone-18-glucuronide, no differences in hypo-and normokalaemic primary aldosteronism were found (sensitivity 45% and 43%, specificity 100%). Conclusions: These data show that the saline infusion test as an established test in classical hypokalaemic primary aldosteronism is not a reliable test in the normokalaemic variant of the disease. Due to its low accuracy, determination of urinary aldosterone metabolites did not prove useful in confirming either normo-or hypokalaemic patients. We conclude from our data that these tests should not be used as confirmatory testing in the normokalaemic variant of primary aldosteronism.European Journal of Endocrinology 154 865-873

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Section: Discussioncontrasting

confidence: 86%

“…This is thought to have the advantage of being independent of circadian variations in plasma levels (22,23). Aldosterone is excreted mainly as tetrahydroaldosterone after metabolization in the liver, and as aldosterone-18-glucuronide produced mainly in the kidney (24).…”

Section: Introductionmentioning

confidence: 99%

Confirmatory testing in normokalaemic primary aldosteronism: the value of the saline infusion test and urinary aldosterone metabolites

Schirpenbach¹,

Seiler²,

Maser-Gluth³

et al. 2006

eur j endocrinol

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“…This is in contrast to the reports by other groups. 18 In addition, sensitivity and specificity could not be improved by the correction for sodium excretion. However, the correction of urinary aldosterone metabolites, especially free aldosterone, for plasma renin concentration rendered acceptable profiles and a very high specificity.…”

Section: Discussionmentioning

confidence: 99%

“…17 Aldosterone is excreted in the urine in three main forms: aldosterone-18-glucuronide (A18G), urinary unconjugated (free) aldosterone (A UR ) and tetrahydroaldosterone (THA), which reflects up to 45% of aldosterone secretion. 18 Urine analysis (24 h) for aldosterone metabolites eliminates most of the posture fluctuations in aldosterone blood values, diurnal variations and episodic secretion of aldosterone by the adrenal glands. The urinary unconjugated (free) aldosterone-to-active renin ratio (A UR /R) proved to be a good independent predictor for surgical curability after adrenalectomy, in subjects with aldosteroneproducing adenomas (APAs).…”

Section: Introductionmentioning

confidence: 99%

Indicators of mineralocorticoid excess in the evaluation of primary aldosteronism

et al. 2010

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It is suggested to use the aldosterone-to-renin ratio (ARR) as a first test in the screening for primary aldosteronism (PA). However, many groups rather rely on the determination of urinary tetrahydroaldosterone secretion; others calculate a ratio of urinary aldosterone to plasma renin activity. The aim of the present study was to evaluate the usefulness of different parameters of aldosterone excess in the case finding of PA. The study included 28 patients with PA and 33 subjects with essential hypertension. Clinical data, which included the hormonal parameters, serum aldosterone, plasma renin concentration, urinary free aldosterone and metabolites and serum and urinary electrolyte levels were analyzed. These indices of aldosterone excess, the ARR, serum sodium to urinary sodium to (serum potassium) 2 to urinary potassium (SUSPPUP) ratio and combinations of these parameters were compared between the groups. Receiver-operating curve analysis revealed that the ARR multiplied by the SUSPPUP ratio (ARRÂSUSPPUP) is the most reliable screening test, with a sensitivity of 92.3% and a specificity of 93.9% (cutoff point 199.2 (mmol l À1 ) À1 ). The combination of ARRÂSUSPPUP ratio with urinary free aldosterone divided by the plasma renin concentration rendered a specificity of 100%. Less useful was the correction of urinary free aldosterone and its metabolites for sodium excretion. Although the ARR and urinary free aldosterone divided by renin are good tests in the screening for PA, the combination of ARR with SUSPPUP ratio is a better indicator of an aldosterone excess and aldosterone action in patients with ongoing antihypertensive medication. Antihypertensive drugs only marginally interfere with the SUSPPUP ratio, but they may influence the ARR, whereby the effects in PA patients seem to be negligible.

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“…For example, PA has been confirmed in patients with plasma aldosterone levels as low as 9 ng/dL. 27 Falsely high serum potassium levels can occur if patients are asked to repeatedly clinch their fists to facilitate blood collection, which, in turn, may obscure evidence of PA. 28,29 To avoid such an effect, blood should ideally be collected without use of this maneuver.…”

Section: Screening For Pamentioning

confidence: 99%

Is There an Unrecognized Epidemic of Primary Aldosteronism? (Pro)

Kaplan

2007

Hypertension

106

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Urinary tetrahydroaldosterone as a screening method for primary aldosteronism: a comparative study

Cited by 50 publications

References 24 publications

Confirmatory testing in normokalaemic primary aldosteronism: the value of the saline infusion test and urinary aldosterone metabolites

Confirmatory testing in normokalaemic primary aldosteronism: the value of the saline infusion test and urinary aldosterone metabolites

Indicators of mineralocorticoid excess in the evaluation of primary aldosteronism

Is There an Unrecognized Epidemic of Primary Aldosteronism? (Pro)

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