A Renin-ssance in Primary Aldosteronism Testing: Obstacles and Opportunities for Screening, Diagnosis, and Management

[摘要] Primary aldosteronism (PA)9 is a group of adrenal disorders characterized by autonomous production of aldosterone independent of angiotensin II (AngII) stimulation. Idiopathic adrenal hyperplasia is the most common cause followed by aldosterone-producing adenomas (APA or Conn syndrome), unilateral adrenal hyperplasia, adrenal carcinoma, and rare familial forms. Aldosterone excess results in sodium and water retention and potassium excretion, leading to volume expansion, concomitant hypertension, and variable degrees of hypokalemia. As the most common form of secondary hypertension, PA is recognized as an important public health concern. The diagnosis is infrequently considered despite widely available screening procedures. In addition to the hypertension, the negative effects of excess aldosterone are thought to be related to inflammation and fibrosis of various target organs. As a result, patients with PA are at increased risk of cardiovascular and chronic kidney disease compared with age-matched and blood pressure–matched patients with essential hypertension. For these reasons early identification and treatment are necessary to prevent morbidity and mortality associated with this curable form of chronic hypertension.The diagnosis of PA relies on biochemical evidence of relative aldosterone excess and confirmation of abnormal aldosterone production using suppression testing. The identification of the PA subtype is primarily accomplished with adrenal venous sampling and imaging studies. The aldosterone-to-renin ratio (ARR) is generally considered the best first-line screening test for hypertensive patients in whom there is clinical suspicion of PA. Excessive and autonomous aldosterone secretion is characteristically accompanied by low or undetectable renin due to feedback inhibition from sodium excess and increased blood pressure. However, no consensus exists for an internationally recognized ARR cutoff and many challenges, from preanalytical to analytical to postanalytical, have hindered the development of definitive guidance on how to interpret the ARR in clinical practice.In this Q&A, 4 experts from around the world discuss the state-of-the-art in …

[学科分类] 过敏症与临床免疫学