Article
Endocrinology & Metabolism
Jun Yang, Stella May Gwini, Lawrence J. Beilin, Markus Schlaich, Michael Stowasser, Morag J. Young, Peter J. Fuller, Trevor A. Mori
Summary: Oral contraception can increase the aldosterone to renin ratio, leading to false positive results in the screening for primary aldosteronism. Until more reliable criteria for primary aldosteronism screening in oral contraception users are established, alternative contraception methods should be considered.
JOURNAL OF CLINICAL ENDOCRINOLOGY & METABOLISM
(2023)
Article
Endocrinology & Metabolism
Elisabeth Ng, Stella May Gwini, Renata Libianto, Kay Weng Choy, Zhong X. Lu, Jimmy Shen, James C. G. Doery, Peter J. Fuller, Jun Yang
Summary: This retrospective cohort study investigated the intra-individual variability of plasma aldosterone concentration (PAC), direct renin concentration (DRC), and aldosterone-to-renin ratio (ARR) in patients with and without primary aldosteronism (PA), without interfering medications. The results demonstrated significant variability in PAC, DRC, and ARR, which was higher than the assays' analytical variability. A substantial proportion of PA patients had ARR values below the cut-off for first-line screening. These findings emphasize the need for multiple ARR measurements in the evaluation of PA.
JOURNAL OF CLINICAL ENDOCRINOLOGY & METABOLISM
(2022)
Article
Endocrinology & Metabolism
Paolo Mulatero, Chiara Bertello, Franco Veglio, Silvia Monticone
Summary: Primary aldosteronism is an overlooked condition with significant mortality and morbidity. The difficulty of screening patients on antihypertensive therapy has resulted in low testing rates. However, interference with medication may not always be necessary for accurate screening.
JOURNAL OF CLINICAL ENDOCRINOLOGY & METABOLISM
(2022)
Article
Endocrinology & Metabolism
Fabio Bioletto, Chiara Lopez, Martina Bollati, Stefano Arata, Matteo Procopio, Federico Ponzetto, Guglielmo Beccuti, Giulio Mengozzi, Ezio Ghigo, Mauro Maccario, Mirko Parasiliti-Caprino
Summary: This study investigated the feasibility of using aldosterone-to-renin ratio (ARR) as a diagnostic criteria for primary aldosteronism (PA) in patients with resistant hypertension (RH). The results showed that in normokalemic patients, ARR had a lower diagnostic accuracy and may not accurately differentiate between PA and essential RH. However, in patients with hypokalemia, ARR had a higher diagnostic accuracy and may serve as a diagnostic criterion for PA.
FRONTIERS IN ENDOCRINOLOGY
(2023)
Review
Pharmacology & Pharmacy
Piotr Jedrusik, Bartosz Symonides, Jacek Lewandowski, Zbigniew Gaciong
Summary: Primary aldosteronism (PA) is a potentially curable form of secondary hypertension that requires measuring renin and aldosterone, followed by confirmatory tests. Various antihypertensive drug classes interfere with PA evaluation, with calcium antagonists and alpha-blockers being the least interfering drugs.
FRONTIERS IN PHARMACOLOGY
(2021)
Article
Endocrinology & Metabolism
Annie Hung, Sumaiya Ahmed, Ankur Gupta, Alexandra Davis, Gregory A. Kline, Alexander A. Leung, Marcel Ruzicka, Swapnil Hiremath, Gregory L. Hundemer
Summary: The sensitivity and specificity of the ARR as a screening test for primary aldosteronism vary widely, suggesting the need for individualized evaluation based on patient population and diagnostic criteria. Despite its limitations, recognizing the accuracy and reliability constraints of the ARR is crucial for informing clinical decision-making appropriately.
JOURNAL OF CLINICAL ENDOCRINOLOGY & METABOLISM
(2021)
Article
Endocrinology & Metabolism
Ana Alice W. Maciel, Thais C. Freitas, Gustavo F. C. Fagundes, Janaina Petenuci, Leticia A. P. Vilela, Luciana P. Brito, Tatiana S. Goldbaum, Maria Claudia N. Zerbini, Felipe L. Ledesma, Fabio Y. Tanno, Victor Srougi, Jose L. Chambo, Maria Adelaide A. Pereira, Fernando M. A. Coelho, Aline C. B. S. Cavalcante, Francisco C. Carnevale, Bruna Pilan, Andrea Pio-Abreu, Joao Silveira, Fernanda M. Consolim-Colombo, Luiz A. Bortolotto, Ana Claudia Latronico, Maria Candida B. Fragoso, Luciano F. Drager, Berenice B. Mendonca, Madson Q. Almeida
Summary: This study evaluated the coefficient of variation (CV) of aldosterone and aldosterone to direct renin concentration ratio (A/DRC) within individuals and its impact on primary aldosteronism (PA) screening. The results showed that the median intra-individual CV of aldosterone and A/DRC was 26.8% and 26.7%. A significant proportion of patients had aldosterone levels below the minimum threshold for PA screening. False negative rates were higher for single aldosterone measurements compared to multiple measurements. Therefore, PA screening should involve at least two screenings with concurrent aldosterone and renin measurements.
JOURNAL OF CLINICAL ENDOCRINOLOGY & METABOLISM
(2023)
Article
Endocrinology & Metabolism
Rui Zhu, Tungalagtamir Shagjaa, Giacomo Rossitto, Brasilina Caroccia, Teresa Maria Seccia, Dario Gregori, Gian Paolo Rossi
Summary: This study evaluated the diagnostic accuracy of exclusion tests for primary aldosteronism compared to the aldosterone to renin ratio. The results showed that exclusion tests did not provide a diagnostic gain over the aldosterone to renin ratio. Therefore, the systematic use of these exclusion tests in clinical practice is not justified by available evidence.
JOURNAL OF CLINICAL ENDOCRINOLOGY & METABOLISM
(2023)
Article
Peripheral Vascular Disease
Gregory P. Veldhuizen, Rawan M. Alnazer, Abraham A. Kroon, Peter W. de Leeuw
Summary: This study aimed to evaluate the variability of aldosterone-to-renin ratio (ARR) in both short-term and long-term measurements. The results showed significant variations in ARR measurements taken on the same day and at longer intervals, with increasing variability as the mean value of ARR increased. Therefore, caution should be exercised when interpreting point-measurements of moderate to high ARR values in a clinical context.
JOURNAL OF HYPERTENSION
(2022)
Article
Medicine, General & Internal
Zhenjie Liu, Xiaohong Deng, Li Luo, Shaopeng Li, Man Li, Qinqin Deng, Weiguo Zhong, Qiang Luo
Summary: The meta-analysis results of this study indicate that aldosterone to renin ratio (ARR) calculated by plasma renin concentration (PRC) has higher diagnostic efficacy compared to ARR calculated by plasma renin activity (PRA). Additionally, within a certain range, a higher threshold for ARR leads to better diagnostic value.
CHINESE MEDICAL JOURNAL
(2022)
Review
Oncology
Hongjiao Gao, Rong Luo, Jindie Li, Haoming Tian
Summary: Through a meta-analysis on the diagnostic efficacy of ADRR in primary aldosteronism, it was found that ADRR has good sensitivity and specificity and can be used for screening PA, but the risk and problematic control should be considered.
ANNALS OF TRANSLATIONAL MEDICINE
(2022)
Review
Peripheral Vascular Disease
John W. Funder, Robert M. Carey
Summary: Primary aldosteronism, the most common secondary form of hypertension, may have a higher prevalence than previously estimated. The screening rate for primary aldosteronism is currently low, and more research is needed to explore screening and treatment methods.
Article
Endocrinology & Metabolism
Mitsuhide Naruse, Masanori Murakami, Takuyuki Katabami, Tomaz Kocjan, Mirko Parasiliti-Caprino, Marcus Quinkler, Matthieu St-Jean, Sam O'Toole, Filippo Ceccato, Ivana Kraljevic, Darko Kastelan, Mika Tsuiki, Jaap Deinum, Edelmiro Menendez Torre, Troy Puar, Athina Markou, George Piaditis, Kate Laycock, Norio Wada, Marianne Aardal Grytaas, Hiroki Kobayashi, Akiyo Tanabe, Chin Voon Tong, Nuria Valdes Gallego, Sven Gruber, Felix Beuschlein, Lydia Kuerzinger, Norlela Sukor, Elena A. B. Aisha Azizan, Oskar Ragnarsson, Michiel F. Nijhoff, Giuseppe Maiolino, Guido Di Dalmazi, Valentina Kalugina, Andre Lacroix, Raluca Maria Furnica, Tomoko Suzuki
Summary: This study investigated the diversity of approaches utilized for each diagnostic step in different expert centers regarding primary aldosteronism (PA). The results showed significant variations in blood sampling conditions, assay methods, screening and confirmatory tests among centers. This diversity may lead to inconsistent diagnosis of PA and limit comparison of evidence between centers. Standardization of the diagnostic process and revisiting the concept of mild PA are necessary.
EUROPEAN JOURNAL OF ENDOCRINOLOGY
(2023)
Article
Endocrinology & Metabolism
Qiao Xiang, Tao Chen, Kai Yu, Yuanmei Li, Qianrui Li, Haoming Tian, Yan Ren
Summary: The captopril challenge test (CCT) is used to diagnose primary aldosteronism (PA) and the interpretation of its results is not standardized. Different indexes in the CCT have varying value in diagnosing PA. Post-CCT aldosterone to renin ratio (ARR) and plasma aldosterone concentration (PAC) are effective in distinguishing PA from essential hypertension (EH), especially when used in combination. Post-CCT PAC may be more useful in identifying unilateral PA compared to bilateral PA.
FRONTIERS IN ENDOCRINOLOGY
(2021)
Article
Medicine, General & Internal
Minyue Jia, Liya Lin, Hanxiao Yu, Boyun Yang, Xiaohong Xu, Xiaoxiao Song
Summary: Since the introduction of the aldosterone-to-renin ratio (ARR) as a screening tool for primary aldosteronism (PA), there has been an increase in reported cases of PA among hypertensive and normotensive subjects. However, the accuracy of ARR as a measure of aldosterone secretory status is influenced by various factors. Therefore, a negative ARR result should be repeated and analyzed carefully if it does not match the clinical picture, and further diagnostic evaluation may be necessary.