Diagnosis
6
Potassium status
Hypokalemia
↓ → ↑ ↓ (FN)
Potassium loading
↑ → ↓ ↑
Dietary sodium
Sodium restriction
↑ ↑ ↑ ↑ (FN)
Sodium loading
↓ ↓ ↓ ↑ (FP)
Other conditions
Advancing age
↓ ↓ ↓ ↑ (FP)
Premenopausal women (vs. males)
b
→ ↑ ↓ ↑ (FP)
Renal impairment
→ ↓ ↑ (FP)
PHA-2
→ ↓ ↑ (FP)
Pregnancy
↑ ↑ ↑ ↓ (FN)
Renovascular HT
↑ ↑ ↑ ↓ (FN)
Malignant HT
↑ ↑ ↑ ↓ (FN)
a
Renin inhibitors lower PRA, but raise DRC. is would be expected to result in false-positive
ARR levels for renin measured as PRA and false negatives for renin measured as DRC.
b
In premenopausal, ovulating women, plasma aldosterone levels measured during the menses or the
proliferative phase of the menstrual cycle are similar to those of men but rise briskly in the luteal
phase. Because renin levels are lower, the ARR is higher than in men for all phases of the cycle,
but especially during the luteal phase during which aldosterone rises to a greater extent than renin.
False positives can occur during the luteal phase, but only if renin is measured as DRC and not
PRA. In preliminary studies, some investigations have found false positives on the current cutoffs
for women in the luteal phase. Accordingly, it would seem sensible to screen women at risk in the
follicular phase, if practicable.
Adapted from J. W. Funder et al: Case detection, diagnosis, and treatment of patients with primary
aldosteronism: an Endocrine Society Clinical Practice Guideline. J Clin Endocrinol Metab.
2008;93:3266–3281, with permission. © Endocrine Society.
Table 2. Factors That May Lead to False-Positive or False-
Negative ARR Results (cont'd)
Factor
Effect on
Aldosterone
Plasma Levels
Effect
on Renin
Levels
Effect
on ARR
