Academic Journal
Inappropriately normal aldosterone levels as the norm for hyperaldosteronism: Use of a modified aldosterone-to-renin ratio to enhance primary aldosteronism detection.
| Τίτλος: | Inappropriately normal aldosterone levels as the norm for hyperaldosteronism: Use of a modified aldosterone-to-renin ratio to enhance primary aldosteronism detection. |
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| Συγγραφείς: | Bauzon J; Center for Endocrine Surgery, Integrated Surgical Institute, Cleveland Clinic, Cleveland, OH., Romero-Velez G; Center for Endocrine Surgery, Integrated Surgical Institute, Cleveland Clinic, Cleveland, OH; Cleveland Clinic Lerner College of Medicine of Case Western Reserve University School of Medicine, Cleveland, OH., Perez-Soto R; Center for Endocrine Surgery, Integrated Surgical Institute, Cleveland Clinic, Cleveland, OH., Berber E; Center for Endocrine Surgery, Integrated Surgical Institute, Cleveland Clinic, Cleveland, OH; Cleveland Clinic Lerner College of Medicine of Case Western Reserve University School of Medicine, Cleveland, OH., Siperstein A; Center for Endocrine Surgery, Integrated Surgical Institute, Cleveland Clinic, Cleveland, OH; Cleveland Clinic Lerner College of Medicine of Case Western Reserve University School of Medicine, Cleveland, OH. Electronic address: sipersa@ccf.org. |
| Πηγή: | Surgery [Surgery] 2026 Oct; Vol. 198, pp. 110473. Date of Electronic Publication: 2026 Jul 22. |
| Τύπος έκδοσης: | Journal Article |
| Γλώσσα: | English |
| Στοιχεία περιοδικού: | Publisher: Mosby Country of Publication: United States NLM ID: 0417347 Publication Model: Print-Electronic Cited Medium: Internet ISSN: 1532-7361 (Electronic) Linking ISSN: 00396060 NLM ISO Abbreviation: Surgery Subsets: MEDLINE |
| Imprint Name(s): | Publication: St. Louis, MO : Mosby Original Publication: St. Louis. |
| Ιατρικοί όροι (MeSH): | Hyperaldosteronism*/diagnosis , Hyperaldosteronism*/blood , Renin*/blood , Aldosterone*/blood , Adrenal Gland Neoplasms*/blood , Adrenal Gland Neoplasms*/diagnosis, Humans ; Female ; Middle Aged ; Retrospective Studies ; Male ; ROC Curve ; Adult ; Sensitivity and Specificity ; Aged |
| Περίληψη: | Background: The aldosterone-to-renin ratio is the preferred screening test for primary aldosteronism, but its performance may be limited by assay variability and threshold definitions. We evaluated the aldosterone-to-renin ratio in a contemporary cohort of primary aldosteronism and nonsecretory tumors. Methods: Patients diagnosed with primary aldosteronism were retrospectively identified at our center from January 2016 to January 2024 and compared with nonsecreting adrenal tumors. An aldosterone-to-renin ratio of 5.7 ng/dL/ng/L was used based on previously established thresholds. Plasma aldosterone and direct renin concentration were plotted to determine optimal differentiation between groups. Receiver operating characteristic curve analysis was used to determine optimal performance. Results: Of 169 patients included, 100 had primary aldosteronism (70 unilateral, 30 bilateral) and 69 had nonsecreting tumors. Scatterplot analysis demonstrated 2 distinct biochemical zones separating primary aldosteronism from non-primary aldosteronism patients. Sixty-seven percent with primary aldosteronism had plasma aldosterone <30 ng/dL (45% with a more conservative limit of 20 ng/dL). A guideline-based aldosterone-to-renin ratio cutoff of 5.7 yielded a 73.5% sensitivity and 100% specificity (area under the curve, 0.984; 95% confidence interval, 0.972-0.995). Using a modified formula (aldosterone-to-renin ratio of 4.0, correction factor of 1.8 to plasma aldosterone), sensitivity improved to 93.5% with a specificity of 93.0% (area under the curve, 0.981; 95% confidence interval, 0.968-0.994), although discernment between models did not achieve significance (P = .07). Conclusion: Aldosterone-to-renin ratio demonstrates reasonable effectiveness in distinguishing primary aldosteronism from nonsecreting tumors in a modern cohort. As elevated aldosterone levels were seen in a minority of patients, suppressed renin was key in establishing a diagnosis. Modifying the classic aldosterone-to-renin ratio formula increased sensitivity without compromising specificity, which may help with diagnosing nonclassic primary aldosteronism presentations. (Copyright © 2026 The Author(s). Published by Elsevier Inc. All rights reserved.) |
| Competing Interests: | Conflict of Interest/Disclosure Dr Romero-Velez reports having consulting agreements with Veracyte. Dr Berber reports having consulting agreements with Medtronic, Ethicon, and Fluoptics. Both have received honoraria for consulting work. The other authors have no potential conflicts to disclose. |
| Substance Nomenclature: | EC 3.4.23.15 (Renin) 4964P6T9RB (Aldosterone) |
| Entry Date(s): | Date Created: 20260811 Date Completed: 20260915 Latest Revision: 20260915 |
| Update Code: | 20260916 |
| DOI: | 10.1016/j.surg.2026.110473 |
| PMID: | 42580016 |
| Βάση Δεδομένων: | MEDLINE |
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