Primary Hyperaldosteronism
المؤلف:
Marcello Ciaccio
المصدر:
Clinical and Laboratory Medicine Textbook 2021
الجزء والصفحة:
p355
2025-09-28
370
Diagnosis of primary hyperaldosteronism begins with a screening test, which includes the relationship between plasma aldosterone and PRA values, followed by a confirmatory test and, finally, investigations to assess the cause of hyperaldosteronism.
The screening test is recommended in patients with:
• Sustained blood pressure >150/100 mmHg, measured on three different days
• Hypertension (blood pressure >140/90 mmHg), resistant to three antihypertensive medications (including a diuretic)
• Blood pressure (<140/90 mmHg) controlled with four or more antihypertensive medications
• Hypertension and spontaneous or diuretic-induced hypokalemia
• Hypertension and adrenal incidentaloma
• Hypertension and sleep apnea
• Hypertension and family history of early-onset hyper tension or cerebrovascular event at a young age (<40 years)
• Hypertension in subjects with at least one first-degree relative with primary hyperaldosteronism
Assessment of the aldosterone/PRA ratio (ARR) reduces the intra-individual variability in plasma aldosterone and renin levels due to changes in sodium intake, serum potassium levels, position (supine or standing), and age.
Determination of MRA must be preceded by discontinuation of antihypertensive medications for at least 6 weeks (varies by drug type). Currently, there is no uniformity in assay methods; therefore, there is wide variability in the cut offs used for ARR. However, when sampling is performed in the morning in a seated patient, the most commonly used cutoff values are in the range 20–40 ng/dL aldosterone per ng/mL/h PRA; levels ≥40 ng/dL plasma aldosterone per ng/ mL/h PRA, in addition to plasma aldosterone concentrations ≥15ng/dL, are indicative of hyperaldosteronism. The MRA is a very sensitive but non-specific test; therefore, the diagnosis must be confirmed or excluded by a dynamic suppression test with a positive MRA. The most commonly used confirmatory tests are the oral sodium loading test, saline infusion test, fludrocortisone suppression test, captopril test, and losartan test.
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