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Veiz E, Kieslich SK, Czesnik D, Herrmann-Lingen C, Meyer T, Staab J. A randomized vagus nerve stimulation study demonstrates that serum aldosterone levels decrease with age in women, but not in men. Sci Rep 2023; 13:14197. [PMID: 37648715 PMCID: PMC10469189 DOI: 10.1038/s41598-023-40113-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/02/2023] [Accepted: 08/04/2023] [Indexed: 09/01/2023] Open
Abstract
In this randomized, sham-controlled study, we explored the effects of acute transcutaneous vagus nerve stimulation (tVNS) on serum aldosterone in 20 younger (21-26 years) and 19 older (40-70 years) healthy participants. Blood samples were collected on two different days before and after a 20-min application of active tVNS at the inner tragus or sham stimulation of the earlobe. Irrespective of the stimulation mode, aldosterone levels decreased from pre- to post-stimulation in both the young (active: β = - 1.610 (- 2.855, - 0.365), p = 0.022; sham: β = - 0.857 (- 2.102, 0.388), p = 0.257) and the old cohort (active: β = - 1.969 (- 3.234, - 0.703), p = 0.005; sham: β = - 1.334 (- 2.600, - 0.069), p = 0.063). Although this decline was significant during active tVNS, the difference in estimated β-coefficients between active and sham stimulation was not statistically significant in either cohort. Nevertheless, aldosterone concentrations showed a significant interaction effect between sex and age (p = 0.001). Among all study participants, younger women (23.3 ± 1.6 years) had the highest mineralocorticoid levels (pre active: 172.1 ± 102.0 pg/ml, pre sham: 214.3 ± 82.3 pg/ml), whereas the lowest were observed in older females (59.4 ± 9.4 years) (pre active: 104.9 ± 85.8 pg/ml, pre sham: 81.1 ± 53.8 pg/ml). This post hoc analysis did not suggest that active auricular tVNS reduces serum aldosterone levels compared to sham stimulation in healthy subjects. However, serum aldosterone levels differed among subjects depending on their age and sex, irrespective of tVNS.
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Affiliation(s)
- Elisabeth Veiz
- Department of Psychosomatic Medicine and Psychotherapy, University Medical Center, Göttingen, Germany
- Department of Neurology, University Medical Center, Göttingen, Germany
| | - Susann-Kristin Kieslich
- Department of Psychosomatic Medicine and Psychotherapy, University Medical Center, Göttingen, Germany
| | - Dirk Czesnik
- Department of Neurology, University Medical Center, Göttingen, Germany
| | - Christoph Herrmann-Lingen
- Department of Psychosomatic Medicine and Psychotherapy, University Medical Center, Göttingen, Germany
- German Center for Cardiovascular Research (DZHK), Partner Site Göttingen, Göttingen, Germany
| | - Thomas Meyer
- Department of Psychosomatic Medicine and Psychotherapy, University Medical Center, Göttingen, Germany.
- German Center for Cardiovascular Research (DZHK), Partner Site Göttingen, Göttingen, Germany.
| | - Julia Staab
- Department of Psychosomatic Medicine and Psychotherapy, University Medical Center, Göttingen, Germany
- German Center for Cardiovascular Research (DZHK), Partner Site Göttingen, Göttingen, Germany
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Khandelwal P, Deinum J. Monogenic forms of low-renin hypertension: clinical and molecular insights. Pediatr Nephrol 2022; 37:1495-1509. [PMID: 34414500 DOI: 10.1007/s00467-021-05246-x] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/08/2021] [Revised: 07/16/2021] [Accepted: 07/19/2021] [Indexed: 11/25/2022]
Abstract
Monogenic disorders of hypertension are a distinct group of diseases causing dysregulation of the renin-angiotensin-aldosterone system and are characterized by low plasma renin activity. These can chiefly be classified as causing (i) excessive aldosterone synthesis (familial hyperaldosteronism), (ii) dysregulated adrenal steroid metabolism and action (apparent mineralocorticoid excess, congenital adrenal hyperplasia, activating mineralocorticoid receptor mutation, primary glucocorticoid resistance), and (iii) hyperactivity of sodium and chloride transporters in the distal tubule (Liddle syndrome and pseudohypoaldosteronism type 2). The final common pathway is plasma volume expansion and catecholamine/sympathetic excess that causes urinary potassium wasting; hypokalemia and early-onset refractory hypertension are characteristic. However, several single gene defects may show phenotypic heterogeneity, presenting with mild hypertension with normal electrolytes. Evaluation is based on careful attention to family history, physical examination, and measurement of blood levels of potassium, renin, and aldosterone. Genetic sequencing is essential for precise diagnosis and individualized therapy. Early recognition and specific management improves prognosis and prevents long-term sequelae of severe hypertension.
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Affiliation(s)
- Priyanka Khandelwal
- Division of Nephrology, Department of Pediatrics, All India Institute of Medical Sciences, New Delhi, 110029, India.
| | - Jaap Deinum
- Department of Internal Medicine, Radboud University Medical Center, Nijmegen, The Netherlands
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Abstract
PURPOSE OF REVIEW Primary aldosteronism (PA) is the most common cause of secondary hypertension. Emerging evidence suggests that PA is associated with cardiovascular, metabolic, and renal complications, that likely develop insidiously, due to prolonged inappropriate mineralocorticoid receptor activation. In this review, we discuss the expanding clinical and pathological spectrum of PA. RECENT FINDINGS Clinical and molecular studies conducted over the recent years reveal that PA traverses a series of contiguous stages. Pre-clinical, but hormonally overt PA has been identified in patients with normal blood pressure, and such patients harbor an increased risk of developing hypertension. Similarly, genetic and histopathological advancements have exposed a spectrum of PA pathology that corresponds to a continuum that spans from pre-clinical stages to florid PA. PA evolves from pre-hypertensive stages to resistant hypertension, along with serious cardiovascular and renal consequences. Early recognition of PA and targeted therapy will be essential for cardiovascular morbidity and mortality prevention in a large number of patients.
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Affiliation(s)
- Taweesak Wannachalee
- Division of Metabolism, Endocrinology, and Diabetes, University of Michigan, 1150 W Medical Center Drive, MSRB II, 5570B, Ann Arbor, MI, 48109, USA.,Division of Endocrinology and Metabolism, Siriraj Hospital, Mahidol University, Bangkok, Thailand
| | - Adina F Turcu
- Division of Metabolism, Endocrinology, and Diabetes, University of Michigan, 1150 W Medical Center Drive, MSRB II, 5570B, Ann Arbor, MI, 48109, USA.
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Uhrová J, Benáková H, Vaníčková Z, Zima T. Comparison of the Chemiluminescence Immunoassay LIAISON® with the Radioimmunoassay for Aldosterone and Renin Measurement. Prague Med Rep 2021; 122:80-95. [PMID: 34137684 DOI: 10.14712/23362936.2021.9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022] Open
Abstract
Determination of renin plasma levels is useful in the diagnosis of hypertension and in the therapeutic follow-up of hypertensive patients. Plasmatic concentration of renin decreases in patients with hypertension due to a primary hyperaldosteronism, contrary to renovascular hypertension where concentrations of renin and aldosterone are both elevated. Blood samples (serum, EDTA plasma) were analysed using two different chemiluminiscent methods CLIA LIAISON® and radioimmunoassay for aldosterone (IMMUNOTECH Beckman Coulter) and renin (Cisbio Bioassay) measurements were compared. We used both methods to ascertain the correlation between serum vs. EDTA plasma levels of aldosterone (RIA, CLIA) and renin (IRMA, CLIA) and to compare aldosterone to renin ratios for CLIA and for radioimmunoassay: serum aldosterone to plasma renin and plasma aldosterone to plasma renin. We compared serum aldosterone CLIA vs. RIA (rP=0.933, P<0.001) and plasma renin determined using CLIA vs. IRMA (rP=0.965, P=0.062). Furthermore, we used both methods to establish the correlation between the serum vs. plasma levels of aldosterone: RIA (rP=0.980, P<0.001); CLIA (rP=0.994, P=0.353) and serum vs. plasma levels of renin: IRMA (rP=0.948, P<0.001); CLIA (rP=0.921, P=0.011). Aldosterone (serum, plasma) to plasmatic renin ratios for CLIA (rP=0.999, P=0.286) and for radioimmunoassay (rP=0.992, P=0.025). Our data demonstrate that renin and aldosterone concentrations obtained using CLIA correlate with renin and aldosterone concentrations using radioimmunoassay methods. Correlation coefficients of pair results ranged from 0.921 to 0.994. Aldosterone (serum, EDTA plasma) to plasmatic renin ratios are comparable and any of them can be used with no significant differences found.
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Affiliation(s)
- Jana Uhrová
- Institute of Medical Biochemistry and Laboratory Diagnostics, First Faculty of Medicine, Charles University and General University Hospital in Prague, Prague, Czech Republic.
| | - Hana Benáková
- Institute of Medical Biochemistry and Laboratory Diagnostics, First Faculty of Medicine, Charles University and General University Hospital in Prague, Prague, Czech Republic
| | - Zdislava Vaníčková
- Institute of Medical Biochemistry and Laboratory Diagnostics, First Faculty of Medicine, Charles University and General University Hospital in Prague, Prague, Czech Republic
| | - Tomáš Zima
- Institute of Medical Biochemistry and Laboratory Diagnostics, First Faculty of Medicine, Charles University and General University Hospital in Prague, Prague, Czech Republic
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Rutledge AC, Johnston A, Bailey D, Booth RA, Edmond P, Leung V, Veljkovic K. Survey of renin and aldosterone testing practices by Ontario laboratories - Providing insight into best practices. Pract Lab Med 2021; 25:e00229. [PMID: 34095415 PMCID: PMC8145751 DOI: 10.1016/j.plabm.2021.e00229] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/30/2020] [Accepted: 04/19/2021] [Indexed: 11/25/2022] Open
Abstract
Objectives Testing for renin and aldosterone in clinical laboratories is complicated by pre-analytical considerations such as the posture for blood collection and susceptibility to cryoactivation of renin. From an analytical perspective, there are both renin activity and renin mass or concentration assays available. There can also be variability in result reporting practices and the aldosterone-renin ratio (ARR) cut-off applied to screen for primary aldosteronism (PA). The Institute for Quality Management in Healthcare (IQMH) Centre for Proficiency Testing surveyed laboratories on their handling of renin and aldosterone testing to better understand current practices. Design and methods An online survey was prepared and sent to 134 Canadian laboratories enrolled in endocrinology proficiency testing with IQMH. Results One hundred twenty Ontario laboratories submitted responses. While only six (5%) laboratories perform testing for both renin and aldosterone, 108 (90%) collect and process specimens to be tested by reference laboratories. The survey revealed considerable variation in practices including the recommended state of patients prior to sample collection (for example, regarding medications or salt intake), the patient posture specifications for sample collection, the precautions taken against cryoactivation of renin, the choice of renin activity or mass assay, and the ARR cut-off used. The available literature on these factors was then reviewed. Conclusions Although there is no standardized procedure for specimen collection, analysis, or result reporting for renin or aldosterone testing, we have attempted to summarize the available literature to develop evidence-based recommendations. Where laboratory practice differs from peers and/or recommended protocols, laboratories should review their practices.
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Affiliation(s)
- Angela C Rutledge
- Endocrinology and Immunology Scientific Committee, Institute for Quality Management in Healthcare, Toronto, Ontario, Canada.,Department of Pathology and Laboratory Medicine, London Health Sciences Centre and St. Joseph's Health Care London, London, Ontario, Canada
| | - Anna Johnston
- Institute for Quality Management in Healthcare, Toronto, Ontario, Canada
| | - Dana Bailey
- Endocrinology and Immunology Scientific Committee, Institute for Quality Management in Healthcare, Toronto, Ontario, Canada.,Dynacare, Brampton, Ontario, Canada
| | - Ronald A Booth
- Endocrinology and Immunology Scientific Committee, Institute for Quality Management in Healthcare, Toronto, Ontario, Canada.,Department of Pathology and Laboratory Medicine, University of Ottawa, The Ottawa Hospital and Eastern Ontario Regional Laboratory Association, Ottawa, Ontario, Canada
| | - Pamela Edmond
- Endocrinology and Immunology Scientific Committee, Institute for Quality Management in Healthcare, Toronto, Ontario, Canada.,Department of Pathology and Laboratory Medicine, London Health Sciences Centre and St. Joseph's Health Care London, London, Ontario, Canada
| | - Victor Leung
- Endocrinology and Immunology Scientific Committee, Institute for Quality Management in Healthcare, Toronto, Ontario, Canada.,Department of Laboratory Medicine, Joseph Brant Hospital, Burlington, Ontario, Canada
| | - Kika Veljkovic
- Endocrinology and Immunology Scientific Committee, Institute for Quality Management in Healthcare, Toronto, Ontario, Canada.,LifeLabs, Toronto, Ontario, Canada
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Veldhuizen GP, Alnazer RM, Kroon AA, de Leeuw PW. Confounders of the aldosterone-to-renin ratio when used as a screening test in hypertensive patients: A critical analysis of the literature. J Clin Hypertens (Greenwich) 2020; 23:201-207. [PMID: 33368994 PMCID: PMC8030008 DOI: 10.1111/jch.14117] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/26/2020] [Revised: 11/17/2020] [Accepted: 11/18/2020] [Indexed: 12/21/2022]
Abstract
The aldosterone‐to‐renin ratio (ARR) is a common screening test for primary aldosteronism in hypertensives. However, there are many factors which could confound the ARR test result and reduce the accuracy of this test. The present review's objective is to identify these factors and to describe to what extent they affect the ARR. Our analysis revealed that sex, age, posture, and sodium‐intake influence the ARR, whereas assay techniques do not. Race and body mass index have an uncertain effect on the ARR. We conclude that several factors can affect the ARR. Not taking these factors into account could lead to misinterpretation of the ARR.
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Affiliation(s)
- Gregory P Veldhuizen
- Department of Internal Medicine, Maastricht University Medical Center & Cardiovascular Research Institute Maastricht, Maastricht, The Netherlands
| | - Rawan M Alnazer
- Department of Internal Medicine, Maastricht University Medical Center & Cardiovascular Research Institute Maastricht, Maastricht, The Netherlands
| | - Abraham A Kroon
- Department of Internal Medicine, Maastricht University Medical Center & Cardiovascular Research Institute Maastricht, Maastricht, The Netherlands
| | - Peter W de Leeuw
- Department of Internal Medicine, Maastricht University Medical Center & Cardiovascular Research Institute Maastricht, Maastricht, The Netherlands
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Abstract
Primary aldosteronism remains a leading cause of secondary hypertension, and its diagnosis and management continue to pose a challenge for clinicians. In this article, we review the diagnosis of primary aldosteronism along with its cardiovascular manifestations. Treatment is described depending on the diagnostic outcome, focusing on medical management with mineralocorticoid receptor antagonists and unilateral adrenalectomy. Although screening and diagnosing hyperaldosteronism follows well-known algorithms, in practice, physicians may find difficulty establishing the best course of action due to complexity in testing and confirming laterality of aldosterone production by the adrenals. Recognizing and treating primary aldosteronism requires a multidisciplinary approach with primary care physicians, cardiologists, endocrinologists, and radiologists working collaboratively.
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Lopez AG, Fraissinet F, Lefebvre H, Brunel V, Ziegler F. Pharmacological and analytical interference in hormone assays for diagnosis of adrenal incidentaloma. Annales d'Endocrinologie 2019; 80:250-258. [DOI: 10.1016/j.ando.2018.11.006] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/30/2018] [Revised: 09/27/2018] [Accepted: 11/19/2018] [Indexed: 12/19/2022]
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Dick SM, Queiroz M, Bernardi BL, Dall’agnol A, Brondani LA, Silveiro SP. Update in diagnosis and management of primary aldosteronism. ACTA ACUST UNITED AC 2018; 56:360-72. [DOI: 10.1515/cclm-2017-0217] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/11/2017] [Accepted: 07/24/2017] [Indexed: 12/17/2022]
Abstract
Abstract
Primary aldosteronism (PA) is a group of disorders in which aldosterone is excessively produced. These disorders can lead to hypertension, hypokalemia, hypervolemia and metabolic alkalosis. The prevalence of PA ranges from 5% to 12% around the globe, and the most common causes are adrenal adenoma and adrenal hyperplasia. The importance of PA recognition arises from the fact that it can have a remarkably adverse cardiovascular and renal impact, which can even result in death. The aldosterone-to-renin ratio (ARR) is the election test for screening PA, and one of the confirmatory tests, such as oral sodium loading (OSL) or saline infusion test (SIT), is in general necessary to confirm the diagnosis. The distinction between adrenal hyperplasia (AH) or aldosterone-producing adenoma (APA) is essential to select the appropriate treatment. Therefore, in order to identify the subtype of PA, imaging exams such as computed tomography or magnetic ressonance imaging, and/or invasive investigation such as adrenal catheterization must be performed. According to the subtype of PA, optimal treatment – surgical for APA or pharmacological for AH, with drugs like spironolactone and amiloride – must be offered.
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Li X, Goswami R, Yang S, Li Q. Aldosterone/direct renin concentration ratio as a screening test for primary aldosteronism: A meta-analysis. J Renin Angiotensin Aldosterone Syst 2016; 17:1470320316657450. [PMID: 27534428 PMCID: PMC5843892 DOI: 10.1177/1470320316657450] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/07/2016] [Accepted: 05/12/2016] [Indexed: 11/26/2022] Open
Abstract
OBJECTIVE The accuracy of aldosterone/direct renin concentration ratio (ADRR) as a screening test in patients with primary aldosteronism (PA) varies widely across the studies. Therefore, we conducted a meta-analysis to assess the accuracy of ADRR. METHODS A literature search was performed in PubMed, Embase, and the Cochrane library published between April 1971-February 2016. Studies focusing on the accuracy of ADRR for PA screening were included. Two authors independently extracted information regarding patient characteristics, antihypertensives status, true positives, true negatives, false positives, and false negatives. The random-effects model was used for statistical analysis. Heterogeneity was explored by subgroup analysis and meta-regression. RESULTS Nine studies involving 974 patients were included. The overall sensitivity, specificity, area under the curve, and diagnostic odds ratio of ADRR were 0.89 (95% confidence interval (CI) 0.84-0.93), 0.96 (95% CI 0.95-0.98), 0.985 and 324 respectively, with substantial heterogeneity. Meta-regression showed that antihypertensive status affects the ADRR and may account for the heterogeneity (p=0.03). Subgroup analysis of patients who discontinued the antihypertensives revealed a sensitivity of 0.99 (95% CI, 0.95-1.00) and a specificity of 0.98 (95% CI, 0.96-0.99). CONCLUSIONS This study demonstrates the efficacy of ADRR as a screening test for PA. However, as antihypertensive drugs can interfere with the interpretation of ADRR, it is recommended to interrupt therapy or at least replace with analogues that do not significantly affect the ADRR value.
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Affiliation(s)
- Xiyue Li
- Department of Endocrinology, The First Affiliated Hospital of Chongqing Medical University, China
| | - Richa Goswami
- Department of Endocrinology, The First Affiliated Hospital of Chongqing Medical University, China
| | - Shumin Yang
- Department of Endocrinology, The First Affiliated Hospital of Chongqing Medical University, China
| | - Qifu Li
- Department of Endocrinology, The First Affiliated Hospital of Chongqing Medical University, China
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Douillard C, Houillier P, Nussberger J, Girerd X. SFE/SFHTA/AFCE Consensus on Primary Aldosteronism, part 2: First diagnostic steps. Ann Endocrinol (Paris) 2016; 77:192-201. [PMID: 27177498 DOI: 10.1016/j.ando.2016.02.003] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/08/2015] [Revised: 02/01/2016] [Accepted: 02/01/2016] [Indexed: 12/09/2022]
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.
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Affiliation(s)
- Claire Douillard
- Service d'endocrinologie et des maladies métaboliques, centre hospitalier régional universitaire de Lille, 59037 Lille, France.
| | - Pascal Houillier
- Département des maladies rénales et métaboliques, hôpital européen Georges-Pompidou, Assistance publique-Hôpitaux de Paris, 75015 Paris, France.
| | - Juerg Nussberger
- Service de médecine interne, unité vasculaire et d'hypertension, centre hospitalier universitaire de Lausanne, CH-1011 Lausanne, Switzerland.
| | - Xavier Girerd
- Pôle cœur métabolisme, unité de prévention cardiovasculaire, groupe hospitalier universitaire Pitié-Salpêtrière, 83, boulevard de l'Hôpital, 75013 Paris, France
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