Intra-individual Variability of Serum Aldosterone and Implications for Primary Aldosteronism Screening

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Maciel, Ana Alice W. ; Freitas, Thais C. ; Fagundes, Gustavo F. C. ; Petenuci, Janaina ; Vilela, Leticia A. P. ; Brito, Luciana P. ; Goldbaum, Tatiana S. ; Zerbini, Maria Claudia N. ; Ledesma, Felipe L. ; Tanno, Fabio Y. ; Srougi, Victor ; Chambo, Jose L. ; Pereira, Maria Adelaide A. ; Coelho, Fernando M. A. ; Cavalcante, Aline C. B. S. ; Carnevale, Francisco C. ; Pilan, Bruna ; Pio-Abreu, Andrea ; Silveira, Joao, V ; Consolim-Colombo, Fernanda M. ; Bortolotto, Luiz A. ; Latronico, Ana Claudia ; Fragoso, Maria Candida B., V ; Drager, Luciano F. ; Mendonca, Berenice B. ; Almeida, Madson Q.

• Document type: Journal article
• Source: JOURNAL OF CLINICAL ENDOCRINOLOGY & METABOLISM; v. N/A, p. 11-pg., 2022-11-22.

Abstract

Context Primary aldosteronism (PA) screening relies on an elevated aldosterone to renin ratio with a minimum aldosterone level, which varies from 10 to 15 ng/dL (277-415.5 pmol/L) using immunoassay. Objective To evaluate intra-individual coefficient of variation (CV) of aldosterone and aldosterone to direct renin concentration ratio (A/DRC) and its impact on PA screening. Methods A total of 671 aldosterone and DRC measurements were performed by the same chemiluminescence assays in a large cohort of 216 patients with confirmed PA and at least 2 screenings. Results The median intra-individual CV of aldosterone and A/DRC was 26.8% and 26.7%. Almost 40% of the patients had at least one aldosterone level <15 ng/dL, 19.9% had at least 2 aldosterone levels <15 ng/dL, and 16.2% had mean aldosterone levels <15 ng/dL. A lower cutoff of 10 ng/dL was associated with false negative rates for PA screening of 14.3% for a single aldosterone measurement, 4.6% for 2 aldosterone measurements, and only 2.3% for mean aldosterone levels. Considering the minimum aldosterone, true positive rate of aldosterone thresholds was 85.7% for 10 ng/dL and 61.6% for 15 ng/dL. An A/DRC >2 ng/dL/mu IU/mL had a true positive rate for PA diagnosis of 94.4% and 98.4% when based on 1 or 2 assessments, respectively. CV of aldosterone and A/DRC were not affected by sex, use of interfering antihypertensive medications, PA lateralization, hypokalemia, age, and number of hormone measurements. Conclusion Aldosterone concentrations had a high CV in PA patients, which results in an elevated rate of false negatives in a single screening for PA. Therefore, PA screening should be based on at least 2 screenings with concomitant aldosterone and renin measurements. (AU)

• FAPESP's process: 19/15873-6 - Investigation of new genetic, clinical and pathological aspects of endocrine arterial hypertension
• Grantee: Madson Queiroz Almeida
• Support Opportunities: Research Projects - Thematic Grants