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Criteria for diagnosing primary aldosteronism on the basis of liquid chromatography-tandem mass spectrometry determinations of plasma aldosterone concentration. J Hypertens 2019; 36:1592-1601. [PMID: 29677048 DOI: 10.1097/hjh.0000000000001735] [Citation(s) in RCA: 20] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
BACKGROUND Primary aldosteronism is affecting about 10% of hypertensive patients. Primary aldosteronism should be diagnosed by screening tests based on plasma aldosterone concentration (PAC) and aldosterone-to-renin ratio (ARR), followed by confirmatory test. The cutoff values for PAC and ARR depend on PAC and plasma renin measurement methods. Liquid chromatography-tandem mass spectrometry (LC-MS/MS), the new gold standard method for aldosterone determination, is now widespread but shows lower values than immunoassays. New cutoff values have yet to be determined with LC-MS/MS PAC. METHODS In a retrospective cohort, we measured PAC by LC-MS/MS in 93 healthy volunteers, 77 patients with essential hypertension and 82 primary aldosteronism patients (42 lateralized, 24 bilateral, 16 primary aldosteronism without adrenal vein sampling) after 30 min in a seated position. RESULTS PAC ranged from 42 to 309 pmol/l in healthy volunteers and from 63 to 362 pmol/l in essential hypertensive patients. A cutoff value of 360 pmol/l for basal PAC had a sensitivity of 90.5% and a specificity of 95.1% to differentiate lateralized primary aldosteronism from essential hypertensive patients. ARR ranged from 2.3 to 22.3 in healthy volunteers and from 3.2 to 55.6 pmol/mU in essential hypertensive patients. Using ROC curves, we selected an ARR of 46 pmol/mU, which provided a sensitivity of 100% and a specificity of 93.4% to distinguish between essential hypertensive and lateralized primary aldosteronism patients (sensitivity 94.4%, specificity 93.9% for the overall primary aldosteronism population). CONCLUSION Criteria for primary aldosteronism screening need to be adapted, given the increasing use of LC-MS/MS to determine PAC. We suggest to use 360 pmol/l and 46 pmol/mU as cutoff values, respectively, for basal PAC and ARR after 30 min of seated rest.
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Eugenio Russmann ML, Delfino L, Fierro F, Santoro S, Peréz M, Caruso G, Glikman P, Gauna A, Lupi S. Hiperaldosteronismo primario: puntos de corte del cociente aldosterona/renina. ENDOCRINOL DIAB NUTR 2019; 66:361-367. [DOI: 10.1016/j.endinu.2018.11.008] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/03/2018] [Revised: 10/24/2018] [Accepted: 11/05/2018] [Indexed: 11/16/2022]
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Yan Y, Wang C, Lu Y, Gong H, Wu Z, Ma X, Li H, Wang B, Zhang X. Mineralocorticoid receptor antagonism protects the aorta from vascular smooth muscle cell proliferation and collagen deposition in a rat model of adrenal aldosterone-producing adenoma. J Physiol Biochem 2017; 74:17-24. [PMID: 29164516 DOI: 10.1007/s13105-017-0600-2] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/08/2016] [Accepted: 11/07/2017] [Indexed: 10/18/2022]
Abstract
The number of patients with adrenal aldosterone-producing adenomas (APAs) has gradually increased. However, even after adenoma resection, some patients still suffer from high systolic blood pressure (SBP), which is possibly due to great arterial remodeling. Moreover, mineralocorticoid receptors (MRs) were found to be expressed in vascular smooth muscle cells (VSMCs). This study aims to determine whether MR antagonism protects the aorta from aldosterone-induced aortic remolding. Male rats were subcutaneously implanted with an osmotic minipumps and randomly divided into four groups: control; aldosterone (1 μg/h); aldosterone plus a specific MR antagonist, eplerenone (100 mg/kg/day); and aldosterone plus a vasodilator, hydralazine (25 mg/kg/day). After 8 weeks of infusion, aortic smooth muscle cell proliferation and collagen deposition, as well as the MDM2 and TGF-β1 expression levels in the aorta, were examined. Model rats with APAs were successfully constructed. Compared with the control rats, the model rats exhibited (1) marked SBP elevation, (2) no significant alteration in aortic morphology, (3) increased VSMC proliferation and MDM2 expression in the aorta, and (4) enhanced total collagen and collagen III depositions in the aorta, accompanied with up-regulated expression of TGF-β1. These effects were significantly inhibited by co-administration with eplerenone but not with hydralazine. These findings suggested that specific MR antagonism protects the aorta from aldosterone-induced VSMC proliferation and collagen deposition.
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Affiliation(s)
- Yongji Yan
- Department of Urology, Dongzhimen Hospital Affiliated to Beijing University of Chinese Medicine, Beijing, People's Republic of China.,Department of Urology, East Section of Dongzhimen Hospital Affiliated to Beijing University of Chinese Medicine, Beijing, People's Republic of China
| | - Chao Wang
- Department of Urology, First People's Hospital of Jining City, Jining, Shandong Province, People's Republic of China
| | - Yiqin Lu
- Department of Gynecology, First People's Hospital of Yunnan Province, Kunming, Yunnan Province, People's Republic of China
| | - Huijie Gong
- Department of Urology, Dongzhimen Hospital Affiliated to Beijing University of Chinese Medicine, Beijing, People's Republic of China.,Department of Urology, East Section of Dongzhimen Hospital Affiliated to Beijing University of Chinese Medicine, Beijing, People's Republic of China
| | - Zhun Wu
- Department of Urology, First Affiliated Hospital of Xiamen University, Xiamen, Fujian Province, People's Republic of China
| | - Xin Ma
- Department of Urology, Chinese People's Liberation Army General Hospital, Military Postgraduate Medical College, 28 Fu Xing Road, Hai Dian District, Beijing, 100853, People's Republic of China
| | - Hongzhao Li
- Department of Urology, Chinese People's Liberation Army General Hospital, Military Postgraduate Medical College, 28 Fu Xing Road, Hai Dian District, Beijing, 100853, People's Republic of China
| | - Baojun Wang
- Department of Urology, Chinese People's Liberation Army General Hospital, Military Postgraduate Medical College, 28 Fu Xing Road, Hai Dian District, Beijing, 100853, People's Republic of China
| | - Xu Zhang
- Department of Urology, Chinese People's Liberation Army General Hospital, Military Postgraduate Medical College, 28 Fu Xing Road, Hai Dian District, Beijing, 100853, People's Republic of China.
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