Aldosterone to renin ratio and 24-h urine aldosterone level – suitability assessment in primary hyperaldosteronism prediction

A 36-year-old woman presented at 16 weeks’ gestation with severe hypertension. In comparison to the non-pregnant reference normal ranges, potassium was 3.1-3.9 mmol/L, aldosterone 2570-3000 pmol/L (N 250-2885) renin was unsuppressed (24-76.4 ng/L (N1.7–23.9)), with aldosterone to renin ratios in the reference range. An adrenal MRI scan demonstrated a 1.8 × 1.4 cm left adrenal adenoma. Primary aldosteronism was strongly suspected and surgery considered. However, she was managed conservatively with labetalol and modified-release nifedipine with no obstetric complications. Post-partum blood pressures remained elevated with normal aldosterone (539 pmol/L), unsuppressed renin (5.2 ng/L) and normal aldosterone-to-renin ratio (104 (N < 144)). Suspected primary hyperaldosteronism is challenging to investigate and manage in pregnancy. The accepted screening and confirmatory tests are either contraindicated or not validated in pregnancy. Pregnancy has significant effects on the renin-angiotensin-aldosterone pathway leading to physiologic elevations in both aldosterone and renin. While primary hyperaldosteronism has been associated with poor pregnancy outcomes, optimal management in pregnancy is not clearly established.

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5971Predictors of the results of the confirmatory tests for the diagnosis of primary hyperaldosteronism in hypertensive patients with an aldosterone-to-renin ratio greater than 20

European Heart Journal ◽

10.1093/eurheartj/ehy566.5971 ◽

2018 ◽

Vol 39 (suppl_1) ◽

Author(s):

R Okamoto ◽

M Taniguchi ◽

Y Onishi ◽

N Kumagai ◽

J Uraki ◽

...

Keyword(s):

Primary Hyperaldosteronism ◽

Hypertensive Patients ◽

Confirmatory Tests ◽

Aldosterone To Renin Ratio

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Predictors of confirmatory test results for the diagnosis of primary hyperaldosteronism in hypertensive patients with an aldosterone-to-renin ratio greater than 20. The SHRIMP study

Hypertension Research ◽

10.1038/s41440-018-0126-1 ◽

2018 ◽

Vol 42 (1) ◽

pp. 40-51 ◽

Cited By ~ 5

Author(s):

Ryuji Okamoto ◽

Masaya Taniguchi ◽

Yuki Onishi ◽

Naoto Kumagai ◽

Junji Uraki ◽

...

Keyword(s):

Primary Hyperaldosteronism ◽

Confirmatory Test ◽

Test Results ◽

Hypertensive Patients ◽

Aldosterone To Renin Ratio

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Twenty-Four-Hour Urinary Aldosterone Predicts Inappropriate Left Ventricular Mass Index in Patients with Primary Aldosteronism

The Scientific World JOURNAL ◽

10.1155/2013/294594 ◽

2013 ◽

Vol 2013 ◽

pp. 1-8 ◽

Cited By ~ 2

Author(s):

Chi-Sheng Hung ◽

Yi-Lwun Ho ◽

Yi-Yao Chang ◽

Vin-Cent Wu ◽

Xue-Ming Wu ◽

...

Keyword(s):

Plasma Renin Activity ◽

Left Ventricular Mass ◽

Primary Aldosteronism ◽

Left Ventricular Mass Index ◽

Plasma Renin ◽

Left Ventricular ◽

Plasma Aldosterone ◽

Renin Activity ◽

Aldosterone Level ◽

Aldosterone To Renin Ratio

Objective. Primary aldosteronism (PA) is associated with inappropriate left ventricular hypertrophy (LVH) in relation to a given gender and body size. There is no ideal parameter to predict the presence of LVH or inappropriate LVH in patients with PA. We investigate the performance of 24-hour urinary aldosterone level, plasma renin activity and aldosterone-to-renin ratio on this task.Methods. We performed echocardiography in 106 patients with PA and 31 subjects with essential hypertension (EH) in a tertiary teaching hospital. Plasma renin activity, aldosterone concentration, and 24-hour urinary aldosterone level were measured.Results. Only 24-hour urinary aldosterone was correlated with left ventricular mass index (LVMI) and excess LVMI among these parameters. The multivariate analysis revealed the urinary aldosterone level as an independent predictor for LVMI and excess LVMI. Analyzing the ability of urinary aldosterone, plasma aldosterone concentration, and plasma aldosterone-to-renin ratio to identify the presence of LVH (ROC AUC = 0.701, 0.568, 0.656, resp.) and the presence of inappropriate LV mass index (defined as measured LVMI in predicting LVMI ratio >135%) (ROC area under curve = 0.61, 0.43, 0.493, resp.) revealed the better performance of 24-hour urinary aldosterone.Conclusions. In conclusion, 24-hour urinary aldosterone level performed better to predict the presence of LVH and inappropriate LVMI in patients with PA.

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The Aldosterone-to-Renin Ratio as a Screening Test in Primary Aldosteronism

BULLETIN OF THE TRANSILVANIA UNIVERSITY OF BRASOV SERIES VI - MEDICAL SCIENCES ◽

10.31926/but.ms.2021.63.14.1.3 ◽

2021 ◽

Vol 14 (63) (1) ◽

pp. 29-36

Author(s):

Manuela Mocanu ◽

Claudia Alexandrina Irimie ◽

Mihai Stelian Vârciu ◽

Marius Irimie

Keyword(s):

Primary Aldosteronism ◽

Screening Test ◽

Target Population ◽

Secondary Hypertension ◽

Primary Hypertension ◽

Primary Hyperaldosteronism ◽

Common Causes ◽

Aldosterone To Renin Ratio

Primary hyperaldosteronism is one of the most common causes of secondary hypertension and it is associated with a higher risk of developing extracardiac complications than that of people diagnosed with primary hypertension. We present a six-month study done at the MedLife Hospital in Brașov on 62 patients who had one or more indications for primary hyperaldosteronism screening. The main conclusions drawn from this study are that there is a strong need for starting screening in primary hyperaldosteronism from an earlier age, as the target population can have a high vulnerability from a cardiovascular and a renal standpoint and that the aldosterone-to-renin ratio screening test should be recommended to a higher number of people in the target population, the positivity rate in the group studied being 47%.

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