title: Laboratory challenges in primary aldosteronism screening and diagnosis.
abstract: OBJECTIVE
  The laboratory has a critical role to play in the screening and diagnosis of primary aldosteronism. This review highlights some of the important analytical considerations and the new developments in the determination of aldosterone and renin.
  
  
  METHODS
  The review considered the published literature and clinical practice guidelines in the area of primary aldosteronism.
  
  
  RESULTS
  A brief introduction to primary aldosteronism is provided. A detailed description of the pre-analytical, analytical and post-analytical considerations for the laboratory determination of aldosterone, renin and the aldosterone to renin ratio follows.
  
  
  CONCLUSIONS
  The lack of internationally accepted standardized methodologies and standard reference material has impeded screening and diagnosis of primary aldosteronism. The development of more accurate and sensitive methods by LC-MS/MS has improved the reliability of aldosterone and renin testing and the availability of commercial chemiluminescent assays may improve the standardization of reporting. Laboratorians need to understand the strengths and weaknesses of their analytical approach and ensure that their interpretative reports are appropriate to their assays.
authors.affiliation: Department of Pathology and Molecular Medicine, McMaster University, 1280 Main Street West, Hamilton, ON L8S 4L8, Canada. Electronic address: muhammad.rehan@medportal.ca.
authors.forename: Muhammad
authors.initials: M
authors.lastname: Rehan
authors.affiliation: Department of Pathology and Laboratory Medicine, University of Toronto, Medical Science Building, 1 King's College Circle, Toronto, ON M5S 1A8, Canada. Electronic address: josh.raizman@mail.utoronto.ca.
authors.forename: Joshua E
authors.initials: JE
authors.lastname: Raizman
authors.affiliation: Department of Clinical Chemistry, University of Liège, CHU Sart-Tilman, Bât B35, 4000 Liège, Belgium. Electronic address: etienne.cavalier@chu.ulg.ac.be.
authors.forename: Etienne
authors.initials: E
authors.lastname: Cavalier
authors.affiliation: Department of Pathology and Molecular Medicine, McMaster University, 1280 Main Street West, Hamilton, ON L8S 4L8, Canada. Electronic address: donwauc@mcmaster.ca.
authors.forename: Andrew C
authors.initials: AC
authors.lastname: Don-Wauchope
authors.affiliation: Department of Pathology and Laboratory Medicine, University of British Columbia, Rm. G227-2211 Wesbrook Mall, Vancouver, BC V6T 2B5, Canada. Electronic address: dtholmes@mail.ubc.ca.
authors.forename: Daniel T
authors.initials: DT
authors.lastname: Holmes
mesh_terms: D000450:Aldosterone / Q000097:blood / Q000652:urine; D006801:Humans; D006929:Hyperaldosteronism / Q000097:blood / Q000175:diagnosis* / Q000652:urine; D006973:Hypertension / Q000097:blood / Q000175:diagnosis / Q000652:urine; D008403:Mass Screening; D017410:Practice Guidelines as Topic; D012083:Renin / Q000097:blood; D053719:Tandem Mass Spectrometry
chemical_list: D000450:Aldosterone; D012083:Renin
keywords: Aldosterone; Hypertension; Mineralocorticoid; Plasma renin activity; Primary aldosteronism; Secondary