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Horm Metab Res 2010; 42(6): 400-405
DOI: 10.1055/s-0030-1248287
Original Article

© Georg Thieme Verlag KG Stuttgart · New York

Salivary Aldosterone as a Diagnostic Aid in Primary Aldosteronism

J. Manolopoulou1 , S. Gerum1 , P. Mulatero2 , P. Rossignol3 , 4 , P.-F. Plouin4 , M. Reincke1 , M. Bidlingmaier1
  • 1Medizinische Klinik Innenstadt der Ludwig-Maximilians-Universität, München, Germany
  • 2Department of Medicine and Experimental Oncology, Division of Medicine and Hypertension, San Giovanni Battista Hospital, Torino, Italy
  • 3Centre d’Investigation Clinique de Nancy 9501 Inserm-CHU de Nancy, Faculté de Médecine, Nancy, France
  • 4Unité d Hypertension artérielle, Hôpital Européen Georges Pompidou, Faculté de Médecine, Paris, France
Further Information

Publication History

received 07.10.2009

accepted 25.01.2010

Publication Date:
09 March 2010 (online)

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Abstract

Recent evidence demonstrates an increased incidence of primary aldosteronism (PA) in approximately 10% of the hypertensive population, making noninvasive and simple screening methods necessary. The aim of the present study was to apply a time-resolved fluorescence immunoassay for the measurement of aldosterone in saliva and the establishment of a cut-off to identify patients with a high likelihood for PA requiring subsequent screening with the aldosterone to renin ratio. Saliva was collected (AM and PM) to ascertain an optimum time with best discriminating power between healthy and disease states. Plasma aldosterone, after overnight recumbency and 4 h later, was collected for posture testing. The participants included 53 PA patients (aged 14–78), 54 with essential hypertension (EH, aged 19–82), and 38 healthy volunteers (aged 19–56). Saliva aldosterone (SA) (median, 25–75th%) in PA was found at 90 pg/ml (61–139) compared to 53 pg/ml (40–85) in EH, with discrimination between PA versus EHs best in the morning (cutoff: 81 pg/ml, 77% sensitivity, 82% specificity). Saliva aldosterone decreases throughout the day in patients with adenomas [APA AM: 123 pg/ml (92–213) vs. PM: 79 pg/ml (41–116)], but not in those with bilateral hyperplasia [BAH AM: 85 pg/ml (59–115)] vs. pm 69 pg/ml (57–114). Morning SA alone allows discrimination between PA and controls, though with significant overlap against EHs, leading to a high number of false positives. More promising is the use of diurnal variation in SA in distinguishing between APA and BAH. The decline in SA seen in patients with APA presents a more constant finding compared to posture testing, which fails to correctly classify a large number of patients.

Key words

aldosterone - steroid hormones - renin-angiotensin-aldosterone system - hypertension

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Correspondence

Dr. M. Bidlingmaier

Medizinische Klinink

Klinikum Innenstadt der Ludwig-Maximilians-Universität

Ziemssenstraße 1

80336 München

Phone: +49/89/5160 2277

Fax: +49/89/5160 4457

Email: martin.bidlingmaier@med.uni-muenchen.de

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