Assistance Publique-Hôpitaux de Paris (AP-HP) Georges Pompidou European Hospital, Physiology Department.
Paris-Descartes University.
J Hypertens. 2018 Jul;36(7):1592-1601. doi: 10.1097/HJH.0000000000001735.
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.
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.
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).
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.
原发性醛固酮增多症影响约 10%的高血压患者。原发性醛固酮增多症应通过基于血浆醛固酮浓度（PAC）和醛固酮-肾素比值（ARR）的筛查试验进行诊断，然后进行确证性试验。PAC 和 ARR 的截止值取决于 PAC 和血浆肾素的测量方法。液相色谱-串联质谱法（LC-MS/MS），醛固酮测定的新标准方法，现在已经广泛应用，但与免疫测定相比显示出较低的值。使用 LC-MS/MS PAC 还需要确定新的截止值。
在一项回顾性队列研究中，我们对 93 名健康志愿者、77 名原发性高血压患者和 82 名原发性醛固酮增多症患者（42 例单侧、24 例双侧、16 例无肾上腺静脉取样的原发性醛固酮增多症）进行了坐位 30 分钟后的 LC-MS/MS 检测。
健康志愿者的 PAC 范围为 42 至 309 pmol/L，原发性高血压患者的 PAC 范围为 63 至 362 pmol/L。基础 PAC 截止值为 360 pmol/L 时，对单侧原发性醛固酮增多症与原发性高血压患者的区分具有 90.5%的敏感性和 95.1%的特异性。健康志愿者的 ARR 范围为 2.3 至 22.3，原发性高血压患者的 ARR 范围为 3.2 至 55.6 pmol/mU。使用 ROC 曲线，我们选择 ARR 为 46 pmol/mU，该值对区分原发性高血压和单侧原发性醛固酮增多症患者具有 100%的敏感性和 93.4%的特异性（对总体原发性醛固酮增多症患者的敏感性为 94.4%，特异性为 93.9%）。
鉴于 LC-MS/MS 越来越多地用于确定 PAC，原发性醛固酮增多症筛查标准需要进行调整。我们建议分别使用 360 pmol/L 和 46 pmol/mU 作为基础 PAC 和 ARR 休息 30 分钟后的截止值。
