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Horm Metab Res 2010; 42(6): 382-391
DOI: 10.1055/s-0030-1248326
Review

© Georg Thieme Verlag KG Stuttgart · New York

Aldosterone to Renin Ratio – A Reliable Screening Tool for Primary Aldosteronism?

A. Tomaschitz1 [*] , S. Pilz1 [*]
  • 1Department of Internal Medicine, Division of Endocrinology and Nuclear Medicine, Medical University of Graz, Graz, Austria
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Publikationsverlauf

received 29.09.2009

accepted 02.02.2010

Publikationsdatum:
11. März 2010 (online)

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Abstract

Primary aldosteronism (PA) is defined as inappropriately high and (relatively or absolutely) autonomous aldosterone secretion, which is not adequately suppressible by sodium loading. Recent evidence shows that the PA prevalence ranges from 3 to 32%. This high prevalence of PA is suggested to be the result of both more intense screening for PA and improvement of laboratory procedures. Inappropriate high aldosterone secretion is paralleled by severe target organ damage, underlining the importance for the identification of PA at an early stage. The aldosterone to renin ratio (ARR), which reflects aldosterone hypersecretion in regard to its principal trophin renin, is currently considered the most reliable tool for PA screening. Accumulating evidence, however, points to a considerable intra-individual variation of this ratio, emphasizing the importance of standardized screening procedures. In particular, laboratory methods, posture, antihypertensive medication, and dietary salt intake are significant effectors of ARR variation. Furthermore, differentiation between low-renin essential hypertension and PA is difficult and probably arbitrary. It is the purpose of the present review to issue the reliability of the ARR as a screening tool for PA. This review also provides an overview about the physiology of the renin-angiotensin-aldosterone system, highlights current laboratory methods for aldosterone and renin determination, and addresses potential influence factors on the ARR.

Key words

aldosterone to renin ratio - primary aldosteronism - adrenal adenoma - adrenal cortex

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1 Both authors contributed equally to the manuscript.

Correspondence

A. TomaschitzMD S. Pilz, MD 

Medical University of Graz

Department of Internal Medicine

Division of Endocrinology and Nuclear Medicine

Auenbruggerplatz 15

8036 Graz

Austria

Telefon: +43/316/385 2383

Fax: +43/316/385 3428

eMail: andreas.tomaschitz@gmx.at

eMail: stefan.pilz@chello.at