title: SFE/SFHTA/AFCE Consensus on Primary Aldosteronism, part 2: First diagnostic steps.
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.
authors.affiliation: Service d'endocrinologie et des maladies métaboliques, centre hospitalier régional universitaire de Lille, 59037 Lille, France. Electronic address: claire.douillard@chru-lille.fr.
authors.forename: Claire
authors.initials: C
authors.lastname: Douillard
authors.affiliation: Département des maladies rénales et métaboliques, hôpital européen Georges-Pompidou, Assistance publique-Hôpitaux de Paris, 75015 Paris, France. Electronic address: pascal.houillier@egp.aphp.fr.
authors.forename: Pascal
authors.initials: P
authors.lastname: Houillier
authors.affiliation: Service de médecine interne, unité vasculaire et d'hypertension, centre hospitalier universitaire de Lausanne, CH-1011 Lausanne, Switzerland. Electronic address: Juerg.Nussberger@chuv.ch.
authors.forename: Juerg
authors.initials: J
authors.lastname: Nussberger
authors.affiliation: Pôle cœur métabolisme, unité de prévention cardiovasculaire, groupe hospitalier universitaire Pitié-Salpêtrière, 83, boulevard de l'Hôpital, 75013 Paris, France.
authors.forename: Xavier
authors.initials: X
authors.lastname: Girerd
mesh_terms: D000367:Age Factors; D000450:Aldosterone / Q000097:blood / Q000652:urine; D000959:Antihypertensive Agents; D001800:Blood Specimen Collection / Q000379:methods; D005260:Female; D006801:Humans; D006929:Hyperaldosteronism / Q000175:diagnosis*; D006973:Hypertension; D008297:Male; D011187:Posture; D011188:Potassium / Q000097:blood; D012083:Renin / Q000097:blood; D012084:Renin-Angiotensin System; D012680:Sensitivity and Specificity; D012737:Sex Factors; D012982:Sodium, Dietary
chemical_list: D000959:Antihypertensive Agents; D012982:Sodium, Dietary; D000450:Aldosterone; D012083:Renin; D011188:Potassium
keywords: Aldosterone; Aldosterone-to-renin ratio (ARR); Aldostérone; Conditions standardisées; Dépistage; Hyperaldostéronisme primaire; Primary aldosteronism; RAR; Rapport aldosterone/rénine; Renin; Rénine; Screening; Standard conditions