Aldosterone-to-renin ratio for diagnosing aldosterone-producing adenoma: A multicentre study

• Published in: Archives of cardiovascular diseases Vol. 105; no. 12; pp. 623 - 630
• Main Authors: Ducher, Michel, Mounier-Véhier, Claire, Baguet, Jean-Philippe, Tartière, Jean-Michel, Sosner, Philippe, Régnier-Le Coz, Sylvie, Perez, Laurence, Fourcade, Jacques, Jabourek, Olivier, Lejeune, Sylvain, Stolz, Arnaud, Fauvel, Jean-Pierre
• Format: Journal Article
• Language: English
• Published: Amsterdam Elsevier Masson SAS 01.12.2012; Elsevier
• Subjects: Adenoma - blood; Adenoma - diagnosis; Adenoma - metabolism; Adrenal Gland Neoplasms - blood; Adrenal Gland Neoplasms - diagnosis; Adrenal Gland Neoplasms - metabolism; Adrenals. Adrenal axis. Renin-angiotensin system (diseases); Adénome de Conn; Aldosterone; Aldosterone - biosynthesis; Aldosterone - blood; Aldosterone-producing adenoma; Aldosterone-to-renin ratio; Aldosteronism; Arterial hypertension. Arterial hypotension; Atherosclerosis (general aspects, experimental research); Biological and medical sciences; Blood and lymphatic vessels; Cardiology. Vascular system; Cardiovascular; Endocrinopathies; Female; Humans; Hypertension; Hypokalaemia; Hypokaliémie; Internal Medicine; Male; Medical sciences; Middle Aged; Non tumoral diseases. Target tissue resistance. Benign neoplasms; Prospective Studies; Rapport aldostérone-rénine; Renin; Renin - blood; Rénine; Hypertension; computed tomography; ARR; blood pressure; Adénome de Conn; Aldosterone-producing adenoma; ROC; Aldosterone; BP; CT; PA; APA; Renin; Hypokalaemia; Hypokaliémie; adrenal venous sampling; Rapport aldostérone-rénine; primary aldosteronism; Aldosteronism; Aldosterone-to-renin ratio; receiver operating characteristic; Rénine; AVS; Endocrinopathy; Hydroelectrolytic balance disorder; Adrenal cortex diseases; Enzyme; Cardiovascular disease; Hyperadrenocorticism; Adenoma; Inorganic element; Peptidases; Metabolic disorder; Conn syndrome; Adrenal gland diseases; Hydrolases; Aspartic endopeptidases; Hypokaliemia; Ratio; Benign neoplasm; Diagnosis; Cardiology; Potassium
• DOI: 10.1016/j.acvd.2012.07.006
• ISSN: 1875-2136

Summary Background Biological diagnostic criteria for diagnosing aldosterone-producing adenoma (APA) are not well-established. Aim The aim of the study was to establish the best biological predictors of APA. Methods A prospective register was implemented in 17 secondary or tertiary hypertension centres. The inclusion criterion was one of the following: onset of hypertension before 40 years of age; history of hypokalaemia; drug-resistant hypertension (resistant to three drugs); or spironolactone efficiency on BP. Results Among the 338 collected cases, 192 patients had two aldosterone-to-renin ratio (ARR) determinations (after 1 hour supine and at least 1 hour upright) on the same occasion. Twenty-five patients (8.2%) had biological hyperaldosteronism and an adrenal adenoma identified by computed tomography. APA was histologically confirmed in all 12 patients who underwent surgery. Histologically proven APAs were used as the ‘gold standard’ in receiver operating characteristic (ROC) curve analysis. ARRs were computed with a minimum renin value set at 5 ng/L to avoid misclassification of so-called ‘low-renin hypertension’. To predict an APA, the ARR area under the ROC curve was 0.93. A supine ARR cut-off value of 32 ng/ng provided the highest sum of sensitivity (92%) plus specificity (92%). On the basis of an ARR ≥ 32 ng/ng in the supine and/or upright position, sensitivity reached 100%. Conclusion The proposed cut-off value of 32 ng/ng for ARR (minimum renin value set at 5 ng/L) in one of two determinations had 100% sensitivity and 72% specificity with 20% positive and 100% negative predictive values for diagnosing APA.