Our evolving understanding of primary aldosteronism

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Figure 1
Our suggested algorithm for screening for and diagnosis of primary aldosteronism.

TABLE 1

Positive thresholds of biochemical testing for primary aldosteronism

Screening tests	More conservative	Most widely accepted		More liberal
Aldosterone-renin ratio (ng/dL per ng/mL/hour)	≥ 40	≥ 30		≥ 20
Plasma aldosterone concentration (ng/dL)	≥ 20	≥ 15		≥ 10
Confirmation aldosterone suppression tests	More conservative		More liberal

With oral salt
24-Hour urinary aldosterone excretion rate (μg)	> 12–14		> 10
With intravenous saline
Plasma aldosterone concentration (ng/dL)	> 10		> 5
With fludrocortisone
Seated plasma aldosterone concentration (ng/dL)	> 6
	with plasma renin activity
	< 1 ng/mL/hour
With captopril
Plasma aldosterone concentration,	< 30%
decrease from baseline
Aldosterone-renin ratio (ng/dL per ng/mL/hour)	> 30		> 20