Primary hyperaldosteronism Screening

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Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1];Associate Editor(s)-in-Chief: Syed Hassan A. Kazmi BSc, MD [2]

Screening

Screening population

The following indviduals should be screened for primary hyperaldosteronism:

1. Blood pressure > 160 / 100 particularly (< 50 years)
2. Resistant hypertension or refractory hypertension (use of > 3 anti-hypertensives and poor control of blood pressure)
3. Hypokalemia (provoked by diuretic therapy or unprovoked)
4. Hypertension and incidentally discovered adrenal adenoma
5. Hypertension with a family history of early-onset hypertension (< 20 years) or cerebrovascular accident at age less than 40 years
6. Hypertensive first-degree relatives of patients with PA

Plasma Aldosterone to Renin Ratio (PAC/PRA)

Protocol

• Drugs that affect the renin–angiotensin-aldosterone axis should be stopped before testing, such as: beta-blockers, ACE inhibitors, ARBs (angiotensin receptor blockers), renin inhibitors, dihydropyridine calcium channel blockers, and central alpha2-agonists, for about fourteen days, and spironolactone, eplerenone, amiloride, and triamterene, and loop diuretics for about twenty eight days.
• The test should be conducted between 8 a.m. and 10 a. m. The patient is advised to stay upright for 2 hours prior to testing, and then sit for about 10 minutes before testing.^[1]

Interpretation

• Primary hyperaldosteronism (Conn's syndrome) is associated with an increased aldosterone levels (PAC) in plasma along with suppressed renin concentration (PRA) due to feedback inhibition of aldosterone on renin levels in the plasma.
• A PAC/PRA ratio of >30 is a strong evidence of primary hyperladosteronism and value >50 is considered diagnostic in the presence of resistant hypertension, hypokalemia and metabolic alkalosis.