A screening test to identify aldosterone-producing adenoma by measuring plasma renin activity. Results in hypertensive patients

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Abstract
To devise a screening test for aldosterone-producing adenoma (APA) among hypertensive patients, the serum Na and K levels, plasma renin activity (PRA), plasma aldosterone concentration and aldosterone-PRA ratio were measured in 348 patients with hypertension. Nine patients with a substantially elevated aldosterone-PRA ratio were selected and hospitalized for further investigations. All 9 patients were then recognized by scintigraphy with labeled cholesterol, venography and surgical excision as having APA. The serum concentration of K was subnormal in 3 of 9 patients with APA. In patients with APA, administration of diuretics and salt restriction significantly elevated PRA. Even under notable diurnal and day-to-day variations of plasma aldosterone concentrations, the aldosterone-PRA ratio was always elevated inappropriately (> 400) in patients with APA. After administration of diuretics, both the PRA and aldosterone levels increased significantly in patients with essential hypertension, but the aldosterone-PRA ratio was < 200. Since the renin-angiotensin system seems to be a major factor controlling aldosterone secretion in normal subjects, it is suggested that an elevation of aldosterone-PRA ratio > 400 is a useful screening tool for the prediction of APA among hypertensive patients.

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