SFE/SFHTA/AFCE Consensus on Primary Aldosteronism, part 2: First diagnostic steps.

Details

Serval ID
serval:BIB_38E4FBD8B60F
Type
Article: article from journal or magazin.
Collection
Publications
Institution
Title
SFE/SFHTA/AFCE Consensus on Primary Aldosteronism, part 2: First diagnostic steps.
Journal
Annales d'endocrinologie
Author(s)
Douillard C., Houillier P., Nussberger J., Girerd X.
ISSN
2213-3941 (Electronic)
ISSN-L
0003-4266
Publication state
Published
Issued date
07/2016
Peer-reviewed
Oui
Volume
77
Number
3
Pages
192-201
Language
english
Notes
Publication types: Journal Article
Publication Status: ppublish
Publication types: Consensus Development Conference ; Journal Article ; Practice Guideline

Abstract
In patients with suspected primary aldosteronism (PA), the first diagnostic step, screening, must have high sensitivity and negative predictive value. The aldosterone-to-renin ratio (ARR) is used because it has higher sensitivity and lower variability than other measures (serum potassium, plasma aldosterone, urinary aldosterone). ARR is calculated from the plasma aldosterone (PA) and plasma renin activity (PRA) or direct plasma renin (DR) values. These measurements must be taken under standard conditions: in the morning, more than 2hours after awakening, in sitting position after 5 to 15minutes, with normal dietary salt intake, normal serum potassium level and without antihypertensive drugs significantly interfering with the renin-angiotensin-aldosterone system. To rule out ARR elevation due to very low renin values, ARR screening is applied only if aldosterone is>240pmol/l (90pg/ml); DR values<5mIU/l are assimilated to 5mIU/l and PRA values<0.2ng/ml/h to 0.2ng/ml/h. We propose threshold ARR values depending on the units used and a conversion factor (pg to mIU) for DR. If ARR exceeds threshold, PA should be suspected and exploration continued. If ARR is below threshold or if plasma aldosterone is<240pmol/l (90pg/ml) on two measurements, diagnosis of PA is excluded.

Keywords
Age Factors, Aldosterone/blood, Aldosterone/urine, Antihypertensive Agents, Blood Specimen Collection/methods, Female, Humans, Hyperaldosteronism/diagnosis, Hypertension, Male, Posture, Potassium/blood, Renin/blood, Renin-Angiotensin System, Sensitivity and Specificity, Sex Factors, Sodium, Dietary
Pubmed
Create date
31/05/2016 16:48
Last modification date
21/08/2019 5:14
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