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Received on February 23, 2004
Accepted on June 18, 2004
Endocrinology and Metabolism |
1 Clinical Chemistry and Pathobiochemistry, Charité-Universitätsmedizin Berlin, Campus Benjamin Franklin, Berlin, Germany
2 Nichols Institute Diagnostics, Bad Vilbel, Germany
3 Department of Internal Medicine II, University of Freiburg, Freiburg, Germany
4 Department of Medicine, University Medical Center Nijmegen, The Netherlands
5 Department of Pharmacology, Ruprecht-Karls-University of Heidelberg, Heidelberg, Germany
6 Endocrinology, Diabetes, and Nutritional Medicine, Charité-Universitätsmedizin Berlin, Campus Benjamin Franklin, Berlin, Germany
* To whom correspondence should be addressed. E-mail: frank.perschel{at}charite.de.
Background: The ratio of plasma aldosterone concentration to plasma renin activity (PAC/PRA) is the most common screening test for primary hyperaldosteronism (PHA), but it is not standardized among laboratories. We evaluated new automated assays for the simultaneous measurement of PAC and plasma renin concentration (PRC).
Methods: We studied 76 healthy normotensive volunteers and 28 patients with confirmed PHA. PAC and PRC were measured immunochemically in EDTA plasma on the Nichols Advantage® chemiluminescence analyzer, and PRA was determined by an activity assay.
Results: In volunteers, PAC varied from 33.3 to 1930 pmol/L, PRA from 1.13 to 19.7 ng · mL-1 · h-1, and PRC from 5.70 to 116 mU/L. PAC/PRA ratios ranged from 4.35 to 494 (pmol/L)/(ng · mL-1 · h-1) and PAC/PRC ratios from 0.69 to 71.0 pmol/mU. In PHA patients, PAC ranged from 158 to 5012 pmol/L, PRA from 0.40 to 1.70 ng · mL-1 · h-1, and PRC from 0.80 to 11.7 mU/L. PAC/PRA ratios were between 298 and 6756 (pmol/L)/(ng · mL-1 · h-1) and PAC/PRC ratios between 105 and 2328 pmol/mU. Whereas PAC or PRC showed broad overlap between PHA patients and volunteers, the PAC/PRC ratio indicated distinct discrimination of these two groups at a cutoff of 71 pmol/mU.
Conclusion: The PAC/PRC ratio offers several practical advantages compared with the PAC/PRA screening method. The present study offers preliminary evidence that it may be a useful screening test for PHA. Further studies are required to validate these results, especially in hypertensive cohorts.
The following articles in journals at HighWire Press have cited this article:
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  N. Sukor, R. D. Gordon, Y. K. Ku, M. Jones, and M. Stowasser Role of Unilateral Adrenalectomy in Bilateral Primary Aldosteronism: A 22-Year Single Center Experience J. Clin. Endocrinol. Metab., July 1, 2009; 94(7): 2437 - 2445. [Abstract] [Full Text] [PDF]
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 R. S. Vasan, S. Demissie, M. Kimura, L. A. Cupples, N. Rifai, C. White, T. J. Wang, J. P. Gardner, X. Cao, E. J. Benjamin, et al. Association of Leukocyte Telomere Length With Circulating Biomarkers of the Renin-Angiotensin-Aldosterone System: The Framingham Heart Study Circulation, March 4, 2008; 117(9): 1138 - 1144. [Abstract] [Full Text] [PDF]
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 I. Quack, O. Vonend, L. Sellin, J. Stegbauer, G. Dekomien, and L. C. Rump A Tale of Two Patients With Mendelian Hypertension Hypertension, March 1, 2008; 51(3): 609 - 614. [Full Text] [PDF]
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 N. I. Parikh, P. Gona, M. G. Larson, T. J. Wang, C. Newton-Cheh, D. Levy, E. J. Benjamin, W. B. Kannel, and R. S. Vasan Plasma renin and risk of cardiovascular disease and mortality: the Framingham Heart Study Eur. Heart J., November 1, 2007; 28(21): 2644 - 2652. [Abstract] [Full Text] [PDF]
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S. J. Hood, K. P. Taylor, M. J. Ashby, and M. J. Brown The Spironolactone, Amiloride, Losartan, and Thiazide (SALT) Double-Blind Crossover Trial in Patients With Low-Renin Hypertension and Elevated Aldosterone-Renin Ratio Circulation, July 17, 2007; 116(3): 268 - 275. [Abstract] [Full Text] [PDF]
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C. Newton-Cheh, C.-Y. Guo, P. Gona, M. G. Larson, E. J. Benjamin, T. J. Wang, S. Kathiresan, C. J. O'Donnell, S. L. Musone, A. L. Camargo, et al. Clinical and Genetic Correlates of Aldosterone-to-Renin Ratio and Relations to Blood Pressure in a Community Sample Hypertension, April 1, 2007; 49(4): 846 - 856. [Abstract] [Full Text] [PDF]
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 M. Stowasser and R. D. Gordon Aldosterone Assays: An Urgent Need for Improvement Clin. Chem., September 1, 2006; 52(9): 1640 - 1642. [Full Text] [PDF]
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C. Schirpenbach, L. Seiler, C. Maser-Gluth, F. Beuschlein, M. Reincke, and M. Bidlingmaier Automated Chemiluminescence-Immunoassay for Aldosterone during Dynamic Testing: Comparison to Radioimmunoassays with and without Extraction Steps Clin. Chem., September 1, 2006; 52(9): 1749 - 1755. [Abstract] [Full Text] [PDF]
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