Skip to main content

Thank you for visiting nature.com. You are using a browser version with limited support for CSS. To obtain the best experience, we recommend you use a more up to date browser (or turn off compatibility mode in Internet Explorer). In the meantime, to ensure continued support, we are displaying the site without styles and JavaScript.

  • Original Article
  • Published:

Fully automated chemiluminescence vs RIA aldosterone assay in primary aldosteronism work-up

Journal of Human Hypertension volume 31, pages 826–830 (2017)Cite this article

Subjects

Abstract

Aldosterone and renin measurement is a cornerstone for primary aldosteronism (PA) diagnosis, but different thresholds are used according to different assays. A fully automated chemiluminescence (CL) immunoassay for renin and aldosterone was recently proposed, showing good performance for PA screening by aldosterone to renin ratio (ARR). This study aimed to define the accuracy of this assay in the screening and in the most popular confirmatory test of autonomous aldosterone production, the intravenous saline loading test (ivSLT). We compared aldosterone results obtained by CL vs radioimmunoassay (RIA) in hypertensive patients investigated for PA (102 baseline and 85 after ivSLT). An excellent correlation was observed between RIA and CL in the entire population for aldosterone (r=0.922) and ARR (r=0.977). For ARR, Deming regression proved a good accordance between methods and, consistent with the fit model, our previous institutional ARR cut-off of 32 (pg ml−1)/(pg ml−1) corresponded to 20 pg ml−1 mU−1 l−1 in CL assay. However, the correlation was weaker in the low end of aldosterone concentrations (r=0.676 for aldosterone <100 pg ml−1), with a concordance of ivSLT results in only 68% of patients. CL assay displays a diagnostic performance very similar to RIA for ARR screening, but it is substantially inferior in the setting of confirmatory tests of autonomous aldosterone secretion, that is, ivSLT.

This is a preview of subscription content, access via your institution

Access options

Buy this article

  • Purchase on Springer Link
  • Instant access to full article PDF
Buy now

Prices may be subject to local taxes which are calculated during checkout

Figure 1
Figure 2
Figure 3

Similar content being viewed by others

References

  1. Gordon RD, Stowasser M, Tunny TJ, Klemm SA, Rutherford JC . High incidence of primary aldosteronism in 199 patients referred with hypertension. Clin Exp Pharmacol Physiol 1994; 21 (4): 315–318.

    Article  CAS  Google Scholar 

  2. Mulatero P, Stowasser M, Loh KC, Fardella CE, Gordon RD, Mosso L et al. Increased diagnosis of primary aldosteronism, including surgically correctable forms, in centers from five continents. J Clin Endocrinol Metab 2004; 89 (3): 1045–1050.

    Article  CAS  Google Scholar 

  3. Rossi GP, Bernini G, Caliumi C, Desideri G, Fabris B, Ferri C et al. A prospective study of the prevalence of primary aldosteronism in 1,125 hypertensive patients. J Am Coll Cardiol 2006; 48 (11): 2293–2300.

    Article  CAS  Google Scholar 

  4. Funder JW, Carey RM, Mantero F, Murad MH, Reincke M, Shibata H et al. The management of primary aldosteronism: case detection, diagnosis, and treatment: an endocrine society clinical practice guideline. J Clin Endocrinol Metab 2016; 101 (5): 1889–1916.

    Article  CAS  Google Scholar 

  5. Rossi GP, Di Bello V, Ganzaroli C, Sacchetto A, Cesari M, Bertini A et al. Excess aldosterone is associated with alterations of myocardial texture in primary aldosteronism. Hypertension 2002; 40 (1): 23–27.

    Article  CAS  Google Scholar 

  6. Milliez P, Girerd X, Plouin PF, Blacher J, Safar ME, Mourad JJ . Evidence for an increased rate of cardiovascular events in patients with primary aldosteronism. J Am Coll Cardiol 2005; 45 (8): 1243–1248.

    Article  CAS  Google Scholar 

  7. Mulatero P, Monticone S, Bertello C, Viola A, Tizzani D, Iannaccone A et al. Long-term cardio- and cerebrovascular events in patients with primary aldosteronism. J Clin Endocrinol Metab 2013; 98 (12): 4826–4833.

    Article  CAS  Google Scholar 

  8. Savard S, Amar L, Plouin PF, Steichen O . Cardiovascular complications associated with primary aldosteronism: a controlled cross-sectional study. Hypertension 2013; 62 (2): 331–336.

    Article  CAS  Google Scholar 

  9. Catena C, Colussi G, Nadalini E, Chiuch A, Baroselli S, Lapenna R et al. Cardiovascular outcomes in patients with primary aldosteronism after treatment. Arch Intern Med 2008; 168 (1): 80–85.

    Article  CAS  Google Scholar 

  10. Funder JW . Primary aldosteronism: are we missing the wood for the trees? Horm Metab Res 2012; 44 (3): 251–253.

    Article  CAS  Google Scholar 

  11. Tiu SC, Choi CH, Shek CC, Ng YW, Chan FK, Ng CM et al. The use of aldosterone-renin ratio as a diagnostic test for primary hyperaldosteronism and its test characteristics under different conditions of blood sampling. J Clin Endocrinol Metab 2005; 90 (1): 72–78.

    Article  CAS  Google Scholar 

  12. Stowasser M, Ahmed AH, Pimenta E, Taylor PJ, Gordon RD . Factors affecting the aldosterone/renin ratio. Horm Metab Res 2012; 44 (3): 170–176.

    Article  CAS  Google Scholar 

  13. Stowasser M, Gordon RD . Aldosterone assays: an urgent need for improvement. Clin Chem 2006; 52 (9): 1640–1642.

    Article  CAS  Google Scholar 

  14. Taylor PJ, Cooper DP, Gordon RD, Stowasser M . Measurement of aldosterone in human plasma by semiautomated HPLC-tandem mass spectrometry. Clin Chem 2009; 55 (6): 1155–1162.

    Article  CAS  Google Scholar 

  15. Ray JA, Kushnir MM, Palmer J, Sadjadi S, Rockwood AL, Meikle AW . Enhancement of specificity of aldosterone measurement in human serum and plasma using 2D-LC-MS/MS and comparison with commercial immunoassays. J Chromatogr B Analyt Technol Biomed Life Sci 2014; 970: 102–107.

    Article  CAS  Google Scholar 

  16. Rossi GP, Ceolotto G, Rossitto G, Seccia TM, Maiolino G, Berton C et al. Prospective validation of an automated chemiluminescence-based assay of renin and aldosterone for the work-up of arterial hypertension. Clin Chem Lab Med 2016; 54 (9): 1441–1450.

    Article  CAS  Google Scholar 

  17. Burrello J, Monticone S, Buffolo F, Lucchiari M, Tetti M, Rabbia F et al. Diagnostic accuracy of aldosterone and renin measurement by chemiluminescent immunoassay and radioimmunoassay in primary aldosteronism. J Hypertens 2016; 34 (5): 920–927.

    Article  CAS  Google Scholar 

  18. Pizzolo F, Zorzi F, Chiecchi L, Consoli L, Aprili I, Guarini P et al. NT-proBNP, a useful tool in hypertensive patients undergoing a diagnostic evaluation for primary aldosteronism. Endocrine 2014; 45 (3): 479–486.

    Article  CAS  Google Scholar 

  19. Olivieri O, Ciacciarelli A, Signorelli D, Pizzolo F, Guarini P, Pavan C et al. Aldosterone to renin ratio in a primary care setting: the Bussolengo study. J Clin Endocrinol Metab 2004; 89 (9): 4221–4226.

    Article  CAS  Google Scholar 

  20. Mulatero P, Milan A, Fallo F, Regolisti G, Pizzolo F, Fardella C et al. Comparison of confirmatory tests for the diagnosis of primary aldosteronism. J Clin Endocrinol Metab 2006; 91 (7): 2618–2623.

    Article  CAS  Google Scholar 

  21. Linnet K . Necessary sample size for method comparison studies based on regression analysis. Clin Chem 1999; 45 (6 Pt 1): 882–894.

    CAS  PubMed  Google Scholar 

  22. Pizzolo F, Corgnati A, Guarini P, Pavan C, Bassi A, Corrocher R et al. Plasma aldosterone assays: comparison between chemiluminescence-based and RIA methods. Clin Chem 2006; 52 (7): 1431–1432.

    Article  CAS  Google Scholar 

  23. Schirpenbach C, Seiler L, Maser-Gluth C, Beuschlein F, Reincke M, Bidlingmaier M . Automated chemiluminescence-immunoassay for aldosterone during dynamic testing: comparison to radioimmunoassays with and without extraction steps. Clin Chem 2006; 52 (9): 1749–1755.

    Article  CAS  Google Scholar 

  24. Mulatero P, Bertello C, Garrone C, Rossato D, Mengozzi G, Verhovez A et al. Captopril test can give misleading results in patients with suspect primary aldosteronism. Hypertension 2007; 50 (2): e26–e27.

    Article  CAS  Google Scholar 

  25. Rossi GP, Belfiore A, Bernini G, Desideri G, Fabris B, Ferri C et al. Comparison of the captopril and the saline infusion test for excluding aldosterone-producing adenoma. Hypertension 2007; 50 (2): 424–431.

    Article  CAS  Google Scholar 

  26. Nanba K, Tamanaha T, Nakao K, Kawashima ST, Usui T, Tagami T et al. Confirmatory testing in primary aldosteronism. J Clin Endocrinol Metab 2012; 97 (5): 1688–1694.

    Article  CAS  Google Scholar 

  27. Manolopoulou J, Fischer E, Dietz A, Diederich S, Holmes D, Junnila R et al. Clinical validation for the aldosterone-to-renin ratio and aldosterone suppression testing using simultaneous fully automated chemiluminescence immunoassays. J Hypertens 2015; 33 (12): 2500–2511.

    Article  CAS  Google Scholar 

Download references

Acknowledgements

The work was performed in part in the LURM (Laboratorio Universitario di Ricerca Medica) Research Center, University of Verona. This study was supported by research grants from the Ministero dell’Istruzione dell’Università e della Ricerca (MIUR) and Fondazione Cariverona.

Author information

Authors and Affiliations

  1. Department of Medicine, Unit of Internal Medicine, University of Verona, Verona, Italy

    F Pizzolo, F Zorzi, C Zaltron, A Castagna, L Bertolone, F Morandini & O Olivieri

  2. Department of Life and Reproduction Sciences, Laboratory of Clinical Biochemistry, University of Verona, Verona, Italy

    G Salvagno & G Lippi

  3. Section of Clinical Biochemistry, University of Verona, Verona, Italy

    B Caruso & C Cocco

Authors
  1. F Pizzolo
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. G Salvagno
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. B Caruso
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. C Cocco
    View author publications

    You can also search for this author in PubMed Google Scholar

  5. F Zorzi
    View author publications

    You can also search for this author in PubMed Google Scholar

  6. C Zaltron
    View author publications

    You can also search for this author in PubMed Google Scholar

  7. A Castagna
    View author publications

    You can also search for this author in PubMed Google Scholar

  8. L Bertolone
    View author publications

    You can also search for this author in PubMed Google Scholar

  9. F Morandini
    View author publications

    You can also search for this author in PubMed Google Scholar

  10. G Lippi
    View author publications

    You can also search for this author in PubMed Google Scholar

  11. O Olivieri
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to F Pizzolo.

Ethics declarations

Competing interests

The authors declare no conflict of interest.

Rights and permissions

Reprints and permissions

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

Pizzolo, F., Salvagno, G., Caruso, B. et al. Fully automated chemiluminescence vs RIA aldosterone assay in primary aldosteronism work-up. J Hum Hypertens 31, 826–830 (2017). https://doi.org/10.1038/jhh.2017.62

Download citation

  • Received:

  • Revised:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1038/jhh.2017.62

This article is cited by

Search

Advanced search

Quick links