scholarly journals Renin- és aldoszteronvizsgálat hypertoniás betegekben

2016 ◽  
Vol 157 (21) ◽  
pp. 830-835
Author(s):  
Tamás Hussein ◽  
Emese Mezősi ◽  
Beáta Bódis ◽  
Orsolya Nemes ◽  
Károly Rucz ◽  
...  
Keyword(s):  
Retrospective Analysis ◽  
Primary Aldosteronism ◽  
Screening Test ◽  
Diagnostic Algorithm ◽  
Ratio Method ◽  
Aldosterone Level ◽  
Hypertensive Patients

Introduction: The diagnostic algorithm of primary aldosteronism is burdened with uncertainties and, recently, it has been suggested that the sensitivity of the aldosterone/renin ratio used as a screening test – based on the suppression aldosterone – is low. Aim: The primary aim was to test the accuracy of aldosterone/renin ratio. Method: In a retrospective analysis of 309 hypertensive patients supine and ambulatory aldosterone levels were independently examined. Results: Aldosterone/renin ratio was elevated in 99 patients of whom 31 exhibited elevated supine aldosterone, as well. In 34 cases supine aldosterone was increased without elevation of the aldosterone/renin ratio. However, only 3 of them had concomitant low renin levels indicating that primary aldosteronism could not be ruled out. Abnormally increased renin was found in 69 patients, but only 59% of them had increased aldosterone level. Conclusion: Sensitivity of aldosterone/renin ratio is high (91%) if used only in justified cases. Orv. Hetil., 2016, 157(21), 830–835.

scholarly journals Aldosterone to Renin Ratio as Screening Tool in Primary Aldosteronism

2018 ◽  
Vol 127 (02/03) ◽  
pp. 84-92
Author(s):  
Katharina Schilbach ◽  
Riia Junnila ◽  
Martin Bidlingmaier
Keyword(s):  
Primary Aldosteronism ◽  
Screening Test ◽  
Screening Tool ◽  
Secondary Hypertension ◽  
Hypertensive Patients ◽  
Assay Methods ◽  
Aldosterone To Renin Ratio

AbstractPrimary aldosteronism (PA) is a severe and often underdiagnosed form of secondary hypertension. Determining the aldosterone to renin ratio (ARR) in hypertensive patients has been shown to be a valuable screening test for identification of patients suffering from PA. Since the introduction of a more widespread ARR screening the number of PA patients significantly increased worldwide. Interpretation of ARR might be challenging: Several factors from posture to interfering drugs affect the ARR and need to be taken into account when collecting samples. In addition, the wide variety of available assay methods and lack of well-established cut-offs present a challenge to the clinician. This review discusses the usefulness and possible difficulties of ARR screening.

scholarly journals Increased Diagnosis of Primary Aldosteronism, Including Surgically Correctable Forms, in Centers from Five Continents

2004 ◽  
Vol 89 (3) ◽  
pp. 1045-1050 ◽  
Author(s):  
Paolo Mulatero ◽  
Michael Stowasser ◽  
Keh-Chuan Loh ◽  
Carlos E. Fardella ◽  
Richard D. Gordon ◽  
...  
Keyword(s):  
Primary Aldosteronism ◽  
Screening Test ◽  
Detection Rate ◽  
Activity Ratio ◽  
Plasma Renin ◽  
Fold Increase ◽  
Hypertensive Patients ◽  
Endocrine Hypertension ◽  
Before And After ◽  
Aldosterone Producing Adenoma

Abstract Primary aldosteronism (PA) is a common form of endocrine hypertension previously believed to account for less than 1% of hypertensive patients. Hypokalemia was considered a prerequisite for pursuing diagnostic tests for PA. Recent studies applying the plasma aldosterone/plasma renin activity ratio (ARR) as a screening test have reported a higher prevalence. This study is a retrospective evaluation of the diagnosis of PA from clinical centers in five continents before and after the widespread use of the ARR as a screening test. The application of this strategy to a greater number of hypertensives led to a 5- to 15-fold increase in the identification of patients affected by PA. Only a small proportion of patients (between 9 and 37%) were hypokalemic. The annual detection rate of aldosterone-producing adenoma (APA) increased in all centers (by 1.3–6.3 times) after the wide application of ARR. Aldosterone-producing adenomas constituted a much higher proportion of patients with PA in the four centers that employed adrenal venous sampling (28–50%) than in the center that did not (9%). In conclusion, the wide use of the ARR as a screening test in hypertensive patients led to a marked increase in the detection rate of PA.

scholarly journals Comparison of Confirmatory Tests for the Diagnosis of Primary Aldosteronism

2006 ◽  
Vol 91 (7) ◽  
pp. 2618-2623 ◽  
Author(s):  
Paolo Mulatero ◽  
Alberto Milan ◽  
Francesco Fallo ◽  
Giuseppe Regolisti ◽  
Francesca Pizzolo ◽  
...  
Keyword(s):  
Primary Aldosteronism ◽  
Screening Test ◽  
Characteristic Curve ◽  
Correct Diagnosis ◽  
Good Alternative ◽  
Receiver Operator Characteristic Curve ◽  
Load Test ◽  
Hypertensive Patients ◽  
Suppression Test ◽  
Aldosterone Producing Adenoma

Abstract Context: Primary aldosteronism (PA) is the most frequent form of secondary hypertension, accounting for up to 5–10% of all hypertensive patients, and the diagnosis of PA can present an important challenge for the clinician. After a positive screening test, the diagnosis is confirmed by a suppression test, often an iv saline load test (SLT) or a fludrocortisone suppression test (FST). The FST is considered by many to be the most reliable but is more complex and expensive. Objective and Design: Our objective was to compare the specificity of SLT with FST for the diagnosis of PA. Patients and Setting: The study included 100 hypertensive patients referred to hypertension units with suspected PA after the screening test. Intervention: All patients underwent FST and SLT. Main Outcome Measures: We assessed plasma aldosterone concentrations (PAC) before and after FST and SLT. Results: After iv SLT, 10.4% of the PA patients were negative and 16.1% of patients with essential hypertension were positive after SLT; that is, a correct diagnosis with SLT was obtained in 88% of patients compared with FST. PAC after SLT and PAC after FST were highly correlated (P < 0.0001). Receiver operator characteristic curve analysis demonstrated that the best cutoff for PAC after SLT was 5 ng/dl. Patients with aldosterone-producing adenoma displayed a smaller reduction of PAC compared with patients with bilateral adrenal hyperplasia; a PAC after SLT greater than 6 ng/dl identified all patients eventually diagnosed as having aldosterone-producing adenoma. Conclusions: This study demonstrates that the iv SLT is a reasonably good alternative to the more expensive and complex FST for the diagnosis of PA after a positive screening test.

Should all Hypertensive Patients be Screened for Primary Aldosteronism?

2019 ◽  
Vol 15 (1) ◽  
pp. 54-56
Author(s):  
Stelina Alkagiet ◽  
Konstantinos Tziomalos
Keyword(s):  
Resistant Hypertension ◽  
Primary Aldosteronism ◽  
Large Scale ◽  
Controlled Trial ◽  
The Other ◽  
Limited Data ◽  
Hypertensive Patients ◽  
Randomized Controlled ◽  
Increased Risk ◽  
Prospective Randomized Controlled Trial

Primary aldosteronism (PA) is not only a leading cause of secondary and resistant hypertension, but is also quite frequent in unselected hypertensive patients. Moreover, PA is associated with increased cardiovascular risk, which is disproportionate to BP levels. In addition, timely diagnosis of PA and prompt initiation of treatment attenuate this increased risk. On the other hand, there are limited data regarding the usefulness of screening for PA in all asymptomatic or normokalemic hypertensive patients. More importantly, until now, no well-organized, large-scale, prospective, randomized controlled trial has proved the effectiveness of screening for PA for improving clinical outcome. Accordingly, until more relevant data are available, screening for PA should be considered in hypertensive patients with spontaneous or diuretic-induced hypokalemia as well as in those with resistant hypertension. However, screening for PA in all hypertensive patients cannot be currently recommended.

Evaluation of Biochemical Conditions Allowing Bypass of Confirmatory Testing in The Workup of Primary Aldosteronism: A Retrospective Study in a French Hypertensive Population

2019 ◽  
Vol 51 (03) ◽  
pp. 172-177 ◽  
Author(s):  
Maud Vivien ◽  
Emilie Deberles ◽  
Remy Morello ◽  
Aimi Haddouche ◽  
David Guenet ◽  
...  
Keyword(s):  
Primary Aldosteronism ◽  
Dynamic Testing ◽  
Challenge Test ◽  
Plasma Aldosterone ◽  
Aldosterone Secretion ◽  
Plasma Aldosterone Concentration ◽  
Hypertensive Patients ◽  
Hypertensive Population ◽  
Tertiary Center ◽  
Aldosterone To Renin Ratio

AbstractThe diagnostic workup for primary aldosteronism includes a screening step using the aldosterone-to-renin ratio (ARR) and a confirmatory step based on dynamic testing of aldosterone secretion autonomy. International guidelines suggest that precise clinical and biochemical conditions may allow the bypassing of the confirmatory step, however, data which validate hormone thresholds defining such conditions are lacking. At our tertiary center, we retrospectively examined a cohort of 173 hypertensive patients screened for PA by the ARR, of whom 120 had positive screening and passed a saline infusion test (SIT) or a captopril challenge test (CCT). Fifty-nine had PA, including 34 Conn adenomas and 25 with idiopathic aldosteronism (IA). Using a threshold of 160 pmol/l, post-SIT plasma aldosterone concentration (PAC) identified PA with 86.4% sensitivity, 94.7% specificity, and a negative predictive value of 92.3%. Of those subjects with a high ARR and a PAC above 550 pmol/l, 93% had a positive SIT, while 100% of subjects with a high ARR, but a PAC under 240 pmol/l had a negative SIT. Our results thus validate the biochemical conditions defined in the French and US guidelines for bypassing the confirmatory step in the workup for PA diagnosis.

Free and Conjugated Catecholamines in Human Hypertension

1978 ◽  
Vol 55 (s4) ◽  
pp. 77s-80s ◽  
Author(s):  
O. Kuchel ◽  
N. T. Buu ◽  
TH. Unger ◽  
J. Genest
Keyword(s):  
Mean Arterial Pressure ◽  
Arterial Pressure ◽  
Primary Aldosteronism ◽  
Adrenal Vein ◽  
Elevated Plasma ◽  
Hypertensive Patients ◽  
Human Hypertension ◽  
Control Subjects ◽  
Urinary Dopamine ◽  
Noradrenaline And Adrenaline

1. Noradrenaline and adrenaline in the adrenal vein of essential hypertensive patients are almost exclusively (99%) unconjugated or free. However only 17% of dopamine is free, the rest is conjugated. The further the site of sampling from the adrenal vein the closer come the free catecholamines to their normal peripheral venous proportion (noradrenaline + adrenaline 20%, dopamine less than 1% of total catecholamines). Deviations from these patterns help to detect the site and type of secretion of phaeochromocytoma. 2. Essential hypertensive patients have, compared with control subjects, higher conjugated plasma dopamine, less urinary free and conjugated dopamine with blunted urinary free dopamine and sodium responsiveness to frusemide. Conjugated noradrenaline + adrenaline, mean arterial pressure and age are positively interrelated. 3. Patients with primary aldosteronism have elevated plasma and urinary total dopamine. After removal of the adenoma urinary dopamine excretion decreases to normal. 4. Elevated conjugated dopamine appears to reflect a compensatory activation of the dopaminergic vasodilator pathway in hypertension, the total urinary dopamine excretion an intrinsic deficiency or compensatory increase of a dopamine-modulated natriuretic mechanism.

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