Intra-individual Variability of Serum Aldosterone and Implications for Primary Aldosteronism Screening

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dc.contributorSistema FMUSP-HC: Faculdade de Medicina da Universidade de São Paulo (FMUSP) e Hospital das Clínicas da FMUSP
dc.contributor.authorMACIEL, Ana Alice W.
dc.contributor.authorFREITAS, Thais C.
dc.contributor.authorFAGUNDES, Gustavo F. C.
dc.contributor.authorPETENUCI, Janaina
dc.contributor.authorVILELA, Leticia A. P.
dc.contributor.authorBRITO, Luciana P.
dc.contributor.authorGOLDBAUM, Tatiana S.
dc.contributor.authorZERBINI, Maria Claudia N.
dc.contributor.authorLEDESMA, Felipe L.
dc.contributor.authorTANNO, Fabio Y.
dc.contributor.authorSROUGI, Victor
dc.contributor.authorCHAMBO, Jose L.
dc.contributor.authorPEREIRA, Maria Adelaide A.
dc.contributor.authorCOELHO, Fernando M. A.
dc.contributor.authorCAVALCANTE, Aline C. B. S.
dc.contributor.authorCARNEVALE, Francisco C.
dc.contributor.authorPILAN, Bruna
dc.contributor.authorPIO-ABREU, Andrea
dc.contributor.authorV, Joao Silveira
dc.contributor.authorCONSOLIM-COLOMBO, Fernanda M.
dc.contributor.authorBORTOLOTTO, Luiz A.
dc.contributor.authorLATRONICO, Ana Claudia
dc.contributor.authorV, Maria Candida B. Fragoso
dc.contributor.authorDRAGER, Luciano F.
dc.contributor.authorMENDONCA, Berenice B.
dc.contributor.authorALMEIDA, Madson Q.
dc.date.accessioned2023-06-21T14:15:39Z
dc.date.available2023-06-21T14:15:39Z
dc.date.issued2023
dc.description.abstractContext Primary aldosteronism (PA) screening relies on an elevated aldosterone to renin ratio with a minimum aldosterone level, which varies from 10 to 15 ng/dL (277-415.5 pmol/L) using immunoassay. Objective To evaluate intra-individual coefficient of variation (CV) of aldosterone and aldosterone to direct renin concentration ratio (A/DRC) and its impact on PA screening. Methods A total of 671 aldosterone and DRC measurements were performed by the same chemiluminescence assays in a large cohort of 216 patients with confirmed PA and at least 2 screenings. Results The median intra-individual CV of aldosterone and A/DRC was 26.8% and 26.7%. Almost 40% of the patients had at least one aldosterone level <15 ng/dL, 19.9% had at least 2 aldosterone levels <15 ng/dL, and 16.2% had mean aldosterone levels <15 ng/dL. A lower cutoff of 10 ng/dL was associated with false negative rates for PA screening of 14.3% for a single aldosterone measurement, 4.6% for 2 aldosterone measurements, and only 2.3% for mean aldosterone levels. Considering the minimum aldosterone, true positive rate of aldosterone thresholds was 85.7% for 10 ng/dL and 61.6% for 15 ng/dL. An A/DRC >2 ng/dL/mu IU/mL had a true positive rate for PA diagnosis of 94.4% and 98.4% when based on 1 or 2 assessments, respectively. CV of aldosterone and A/DRC were not affected by sex, use of interfering antihypertensive medications, PA lateralization, hypokalemia, age, and number of hormone measurements. Conclusion Aldosterone concentrations had a high CV in PA patients, which results in an elevated rate of false negatives in a single screening for PA. Therefore, PA screening should be based on at least 2 screenings with concomitant aldosterone and renin measurements.eng
dc.description.indexMEDLINE
dc.description.indexPubMed
dc.description.indexWoS
dc.description.indexScopus
dc.description.sponsorshipSao Paulo Research Foundation (FAPESP) [2019/15873-6]
dc.identifier.citationJOURNAL OF CLINICAL ENDOCRINOLOGY & METABOLISM, v.108, n.5, p.1143-1153, 2023
dc.identifier.doi10.1210/clinem/dgac679
dc.identifier.eissn1945-7197
dc.identifier.issn0021-972X
dc.identifier.urihttps://observatorio.fm.usp.br/handle/OPI/54057
dc.language.isoeng
dc.publisherENDOCRINE SOCeng
dc.relation.ispartofJournal of Clinical Endocrinology & Metabolism
dc.rightsrestrictedAccesseng
dc.rights.holderCopyright ENDOCRINE SOCeng
dc.subjectprimary aldosteronismeng
dc.subjectaldosteroneeng
dc.subjectrenineng
dc.subjectscreeningeng
dc.subjectvariabilityeng
dc.subject.otherdiagnosiseng
dc.subject.otherrenineng
dc.subject.otherprevalenceeng
dc.subject.otherconsensuseng
dc.subject.otherguidelineseng
dc.subject.othermanagementeng
dc.subject.othersecretioneng
dc.subject.otheroutcomeseng
dc.subject.otherratioeng
dc.subject.otherassayeng
dc.subject.wosEndocrinology & Metabolismeng
dc.titleIntra-individual Variability of Serum Aldosterone and Implications for Primary Aldosteronism Screeningeng
dc.typearticleeng
dc.type.categoryoriginal articleeng
dc.type.versionpublishedVersioneng
dspace.entity.typePublication
hcfmusp.author.externalVILELA, Leticia A. P.:Univ Sao Paulo, Hosp Clin, Serv Endocrinol & Metabol,Fac Med, Unidade Adrenal,Lab Hormonios & Genet Mol LIM 42, BR-05403000 Sao Paulo, Brazil; Univ Fed Uberlandia, Dept Clin Med, Disciplina Endocrinol, Fac Med, BR-38400902 Uberlandia, MG, Brazil
hcfmusp.citation.scopus2
hcfmusp.contributor.author-fmusphcANA ALICE WOLF MACIEL
hcfmusp.contributor.author-fmusphcTHAIS CASTANHEIRA DE FREITAS RESENDE
hcfmusp.contributor.author-fmusphcGUSTAVO FREITAS CARDOSO FAGUNDES
hcfmusp.contributor.author-fmusphcJANAINA PETENUCI
hcfmusp.contributor.author-fmusphcLUCIANA PINTO BRITO
hcfmusp.contributor.author-fmusphcTATIANA SILVA GOLDBAUM
hcfmusp.contributor.author-fmusphcMARIA CLAUDIA NOGUEIRA ZERBINI
hcfmusp.contributor.author-fmusphcFELIPE LOURENCO LEDESMA
hcfmusp.contributor.author-fmusphcFABIO YOSHIAKI TANNO
hcfmusp.contributor.author-fmusphcVICTOR SROUGI
hcfmusp.contributor.author-fmusphcJOSE LUIS CHAMBO
hcfmusp.contributor.author-fmusphcMARIA ADELAIDE ALBERGARIA PEREIRA
hcfmusp.contributor.author-fmusphcFERNANDO GOMES DA SILVA COELHO
hcfmusp.contributor.author-fmusphcALINE CRISTINE BARBOSA SANTOS CAVALCANTE
hcfmusp.contributor.author-fmusphcFRANCISCO CESAR CARNEVALE
hcfmusp.contributor.author-fmusphcBRUNA FERREIRA PILAN
hcfmusp.contributor.author-fmusphcANDREA PIO DE ABREU
hcfmusp.contributor.author-fmusphcJOAO VICENTE DA SILVEIRA
hcfmusp.contributor.author-fmusphcFERNANDA MARCIANO CONSOLIM COLOMBO
hcfmusp.contributor.author-fmusphcLUIZ APARECIDO BORTOLOTTO
hcfmusp.contributor.author-fmusphcANA CLAUDIA LATRONICO XAVIER
hcfmusp.contributor.author-fmusphcMARIA CANDIDA BARISSON VILLARES FRAGOSO
hcfmusp.contributor.author-fmusphcLUCIANO FERREIRA DRAGER
hcfmusp.contributor.author-fmusphcBERENICE BILHARINHO DE MENDONCA
hcfmusp.contributor.author-fmusphcMADSON QUEIROZ DE ALMEIDA
hcfmusp.description.beginpage1143
hcfmusp.description.endpage1153
hcfmusp.description.issue5
hcfmusp.description.volume108
hcfmusp.origemWOS
hcfmusp.origem.pubmed36413507
hcfmusp.origem.scopus2-s2.0-85152492201
hcfmusp.origem.wosWOS:000902375600001
hcfmusp.publisher.cityWASHINGTONeng
hcfmusp.publisher.countryUSAeng
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