Renin and Aldosterone in RAAS
(Renin-Angiotensin-Aldosterone System)
Different direction of renin and aldosterone in primary and secondary hyperaldosteronism
The syndrome of primary aldosteronism was first described by Conn in 1955 . It is characterized by hypertension, suppressed plasma renin activity (PRA), increased plasma aldosterone concentration (PAC), and insuppressible aldosterone levels in the blood or urine.
PA signs and symptoms are nonspecific. These may include:
PA diagnosis is insufficient
All patients with hypertension should get tested
ARR is a useful tool for PA detection
ARR screening leads to 10-fold increase in the annual detection rate of primary aldosteronism.
Distinguishing the subtype of primary aldosteronism is critical to deciding on the appropriate therapy
Subtyping algorithm
APA, aldosterone-producing adenoma;
AVS, adrenal venous sampling;
CT, computed tomography;
IHA, idiopathic hyperaldosteronism; PA, primary aldosteronism;
PAH, primary adrenal hyperplasia.
Due to the limitation of computerized Tomography, adrenal venous sampling is needed
Mindray renin & aldosterone assay
References
[1] Young, WF (Mayo Clinic, Rochester, MN, USA). Diagnosis and treatment of primary aldosteronism: practical clinical perspectives (Review). J Intern Med 2019; 285: 126– 148.
[2] https://www.amazon.com/Secondary-Hypertension-Presentation-Diagnosis-Treatment/dp/ 1588291413> [Accessed 25 March 2021].
[3] <Effect of age on aldosterone/renin ratio (ARR) and comparison of screening accuracy of ARR plus elevated serum aldosterone concentration for primary aldosteronism screening in different age groups> Yin G, Zhang S Endocrine. 2012 Aug; 42(1):182-9.
[4] Williams textbook of endocrinology 13th edition
[5] Young WF, Stanson AW, Thompson GB, et al. Role for adrenal venous sampling in primary aldosteronism. Surgery. 2004;136:1227-1235
