OBJECTIVES: Due to the widespread use of the aldosterone to renin ratio (ARR),primary aldosteronism is currently recognized as a frequent cause of secondaryhypertension. After a positive screening, primary aldosteronism diagnosis needsconfirmation by an inhibitory test such as intravenous saline load (ivSLT). Theaim of the present study was to investigate the role of female hormones inprimary aldosteronism diagnosis, by evaluating possible differences by sex on ARRscreening, on the rate of ivSLT response and analyzing the influence of free and oral contraceptive-induced menstrual cycle on ARR.METHODS: We examined ARR in 103 healthy normotensive volunteers, 81 hypertensive patients who underwent ivSLT, 33 healthy women during free menstrual cycle andafter oral contraceptive therapy.RESULTS: A significantly higher proportion of normotensive women than men had an elevated ARR (13.6 versus 2.3%, P < 0.05). In 44 out of 81 hypertensive patients,diagnosis of primary aldosteronism was confirmed by ivSLT. Patients with positiveand negative ivSLT differed only for sex distribution: 85.2% of men had theprimary aldosteronism diagnosis confirmed, compared with 38.9% of women. Inhealthy women, renin and aldosterone concentrations increased from the follicularto luteal phase of menstrual period, with unchanged ARR. By contrast, reninnearly halved, aldosterone slightly decreased and ARR doubled after oralcontraceptive therapy.CONCLUSION: ARR screening fails to predict positive ivSLT in most (60.2%)hypertensive women as compared with 14.8% of hypertensive men. ARR is more often increased in normotensive women than men. Oral contraceptive may affect ARRcontributing to the diagnostic inaccuracy in women.
Effects Of Female Sex Hormones And Contraceptive Pill On The Diagnostic Work-Up For Primary Aldosteronism
PIZZOLO, Francesca;RAFFAELLI, Ricciarda;CHIECCHI, Laura;PAVAN, Chiara;CONSOLI, Letizia;GUARINI, Patrizia;GUIDI, Giancesare;FRANCHI, Massimo Piergiuseppe;CORROCHER, Roberto;OLIVIERI, Oliviero
2010-01-01
Abstract
OBJECTIVES: Due to the widespread use of the aldosterone to renin ratio (ARR),primary aldosteronism is currently recognized as a frequent cause of secondaryhypertension. After a positive screening, primary aldosteronism diagnosis needsconfirmation by an inhibitory test such as intravenous saline load (ivSLT). Theaim of the present study was to investigate the role of female hormones inprimary aldosteronism diagnosis, by evaluating possible differences by sex on ARRscreening, on the rate of ivSLT response and analyzing the influence of free and oral contraceptive-induced menstrual cycle on ARR.METHODS: We examined ARR in 103 healthy normotensive volunteers, 81 hypertensive patients who underwent ivSLT, 33 healthy women during free menstrual cycle andafter oral contraceptive therapy.RESULTS: A significantly higher proportion of normotensive women than men had an elevated ARR (13.6 versus 2.3%, P < 0.05). In 44 out of 81 hypertensive patients,diagnosis of primary aldosteronism was confirmed by ivSLT. Patients with positiveand negative ivSLT differed only for sex distribution: 85.2% of men had theprimary aldosteronism diagnosis confirmed, compared with 38.9% of women. Inhealthy women, renin and aldosterone concentrations increased from the follicularto luteal phase of menstrual period, with unchanged ARR. By contrast, reninnearly halved, aldosterone slightly decreased and ARR doubled after oralcontraceptive therapy.CONCLUSION: ARR screening fails to predict positive ivSLT in most (60.2%)hypertensive women as compared with 14.8% of hypertensive men. ARR is more often increased in normotensive women than men. Oral contraceptive may affect ARRcontributing to the diagnostic inaccuracy in women.
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