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Variability in the Renin/Aldosterone Profile under Random and Standardized Sampling Conditions in Primary Aldosteronism

Department of Medicine, Institute of Clinical Endocrinology (A.T., M.N., S.T., K. Ta.), Kidney Center (K.Ts.), Tokyo Women’s Medical University, Tokyo 162-8666, Japan; and Institute of Gerontology, Nippon Medical School (T.I.), Kawasaki, Kanagawa 211-8533, Japan

Address all correspondence and requests for reprints to: Akiyo Tanabe, M.D., Department of Medicine, Institute of Clinical Endocrinology, Tokyo Women’s Medical University, 8-1 Kawada-cho, Shinjukuku, Tokyo 162-8666, Japan. E-mail: address: akiyotana{at}endm.twmu.ac.jp.

An increased plasma aldosterone concentration (PAC) with decreased plasma renin activity (PRA) is the abnormal endocrine finding in primary aldosteronism (PA). However, it remains unknown whether this profile is universal when blood samples are obtained in a random manner. We retrospectively evaluated the renin/aldosterone profile in 71 patients with PA due to unilateral adrenal adenoma. Blood samples were obtained randomly at an out-patient clinic and under standardized conditions during hospitalization before surgery. The frequency of PAC above 15 ng/dl, PRA below 0.5 ng angiotensin I/ml·h, and a PAC/PRA ratio greater than 35 was determined. These three variables showed a large intra- and interpatient variation. At least one measurement of PAC, PRA, and PAC/PRA ratio was in the normal range in 39%, 48%, and 31% of patients, respectively. Only 37% of patients always had the characteristic profile associated with PA. The mean values of PAC at the out-patient clinic were slightly, but significantly, lower than those in the hospital. These results clearly demonstrated that the renin/aldosterone profile in PA is not always abnormal due in part to conditions for blood sampling. We conclude that a single normal PAC, PRA, or PAC/PRA ratio does not excluded the diagnosis of PA in a hypertensive patient, but repeated measurements yields one or more abnormal parameters in the vast majority of patients. The PAC/PRA ratio is recommended to use as a screening, but other testing is required to arrive at the correct diagnosis.

This work was supported in part by research grants for Akiyo Tanabe from the Toshiko Yamakawa Research Award of Tokyo Women’s Medical University and the Japan Association of Women’s Doctors.

Abbreviations: Ang I, Angiotensin I; K, potassium; PA, primary aldosteronism; PAC, plasma aldosterone concentration; PRA, plasma renin activity.

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