Stephanie Baron1,2,3, Laurence Amar2,4,5, Anne-Laure Faucon2,4, Anne Blanchard2,3,6, Laurence Baffalie1, Catherine Faucard1, Simon Travers7, Jean-Yves Pagny8, Michel Azizi2,4,9, Pascal Houillier1,2,3. 1. Assistance Publique-Hôpitaux de Paris (AP-HP) Georges Pompidou European Hospital, Physiology Department. 2. Paris-Descartes University. 3. INSERM UMRS 1138 - CNRS ERL 8228, Paris. 4. Assistance Publique-Hôpitaux de Paris (AP-HP) Georges Pompidou European Hospital, Hypertension Unit. 5. INSERM UMR 970, Paris Cardiovascular Research Center. 6. Assistance Publique-Hôpitaux de Paris (AP-HP) Georges Pompidou European Hospital, Clinical Investigations Center 1418. 7. Assistance Publique-Hôpitaux de Paris (AP-HP), Robert Debré Hospital, Biochemistry Department. 8. Assistance Publique- Hôpitaux de Paris (AP-HP) Georges Pompidou European Hospital, Interventional Radiology, Paris, France. 9. INSERM, CIC1418, Paris.
Abstract
BACKGROUND: Primary aldosteronism is affecting about 10% of hypertensive patients. Primary aldosteronism should be diagnosed by screening tests based on plasma aldosterone concentration (PAC) and aldosterone-to-renin ratio (ARR), followed by confirmatory test. The cutoff values for PAC and ARR depend on PAC and plasma renin measurement methods. Liquid chromatography-tandem mass spectrometry (LC-MS/MS), the new gold standard method for aldosterone determination, is now widespread but shows lower values than immunoassays. New cutoff values have yet to be determined with LC-MS/MS PAC. METHODS: In a retrospective cohort, we measured PAC by LC-MS/MS in 93 healthy volunteers, 77 patients with essential hypertension and 82 primary aldosteronism patients (42 lateralized, 24 bilateral, 16 primary aldosteronism without adrenal vein sampling) after 30 min in a seated position. RESULTS: PAC ranged from 42 to 309 pmol/l in healthy volunteers and from 63 to 362 pmol/l in essential hypertensive patients. A cutoff value of 360 pmol/l for basal PAC had a sensitivity of 90.5% and a specificity of 95.1% to differentiate lateralized primary aldosteronism from essential hypertensive patients. ARR ranged from 2.3 to 22.3 in healthy volunteers and from 3.2 to 55.6 pmol/mU in essential hypertensive patients. Using ROC curves, we selected an ARR of 46 pmol/mU, which provided a sensitivity of 100% and a specificity of 93.4% to distinguish between essential hypertensive and lateralized primary aldosteronism patients (sensitivity 94.4%, specificity 93.9% for the overall primary aldosteronism population). CONCLUSION: Criteria for primary aldosteronism screening need to be adapted, given the increasing use of LC-MS/MS to determine PAC. We suggest to use 360 pmol/l and 46 pmol/mU as cutoff values, respectively, for basal PAC and ARR after 30 min of seated rest.
BACKGROUND: Primary aldosteronism is affecting about 10% of hypertensivepatients. Primary aldosteronism should be diagnosed by screening tests based on plasma aldosterone concentration (PAC) and aldosterone-to-renin ratio (ARR), followed by confirmatory test. The cutoff values for PAC and ARR depend on PAC and plasma renin measurement methods. Liquid chromatography-tandem mass spectrometry (LC-MS/MS), the new gold standard method for aldosterone determination, is now widespread but shows lower values than immunoassays. New cutoff values have yet to be determined with LC-MS/MS PAC. METHODS: In a retrospective cohort, we measured PAC by LC-MS/MS in 93 healthy volunteers, 77 patients with essential hypertension and 82 primary aldosteronism patients (42 lateralized, 24 bilateral, 16 primary aldosteronism without adrenal vein sampling) after 30 min in a seated position. RESULTS: PAC ranged from 42 to 309 pmol/l in healthy volunteers and from 63 to 362 pmol/l in essential hypertensivepatients. A cutoff value of 360 pmol/l for basal PAC had a sensitivity of 90.5% and a specificity of 95.1% to differentiate lateralized primary aldosteronism from essential hypertensivepatients. ARR ranged from 2.3 to 22.3 in healthy volunteers and from 3.2 to 55.6 pmol/mU in essential hypertensivepatients. Using ROC curves, we selected an ARR of 46 pmol/mU, which provided a sensitivity of 100% and a specificity of 93.4% to distinguish between essential hypertensive and lateralized primary aldosteronism patients (sensitivity 94.4%, specificity 93.9% for the overall primary aldosteronism population). CONCLUSION: Criteria for primary aldosteronism screening need to be adapted, given the increasing use of LC-MS/MS to determine PAC. We suggest to use 360 pmol/l and 46 pmol/mU as cutoff values, respectively, for basal PAC and ARR after 30 min of seated rest.
Authors: Graeme Eisenhofer; Max Kurlbaum; Mirko Peitzsch; Georgiana Constantinescu; Hanna Remde; Manuel Schulze; Denise Kaden; Lisa Marie Müller; Carmina T Fuss; Sonja Kunz; Sylwia Kołodziejczyk-Kruk; Sven Gruber; Aleksander Prejbisz; Felix Beuschlein; Tracy Ann Williams; Martin Reincke; Jacques W M Lenders; Martin Bidlingmaier Journal: J Clin Endocrinol Metab Date: 2022-04-19 Impact factor: 6.134