The Journal of clinical endocrinology and metabolism
September 16, 2026 · via Europe PMC
Interpreting Serial Aldosterone-to-Renin Ratio Measurements in the Diagnostic Work-up of Primary Aldosteronism.
Parasiliti-Caprino M, Bollati M, Barba L, +6 more, Maccario M.
AI summary — for doctors, generated from the abstract only
In a retrospective study of 342 patients tested twice for primary aldosteronism, requiring both aldosterone-to-renin ratio (ARR) tests to be positive gave the best overall diagnostic accuracy, while discordant results identified an intermediate-probability group.
What was studied
A retrospective study at a referral center for endocrine hypertension compared four strategies for interpreting two serial ARR measurements (first ARR alone, mean of both, at least one positive, or both positive) for diagnosing primary aldosteronism (PA), evaluated against different thresholds.
Key findings
- Among 342 patients with two ARR measurements, 214 (62.6%) had confirmed PA.
- At an ARR threshold of 49, requiring both measurements positive gave the highest balanced accuracy (77.1%), with 82.2% sensitivity and 71.9% specificity.
- PA prevalence rose from 21.3% (both ARR negative) to 83.0% (both ARR positive); discordant results (one positive, one negative) carried intermediate PA probabilities of 36.8% and 36.0%.
- Averaging the first two ARR values modestly improved discrimination, with AUC increasing from 0.772 to 0.803 when combined with a confirmatory test threshold (p=0.015).
Clinical relevance
The findings suggest that interpreting two serial ARR results together, rather than relying on a single measurement, could improve diagnostic stratification for primary aldosteronism, and that discordant results should prompt further clinical and biochemical evaluation rather than a simple positive/negative call.
Who should care
Limitations
Single-center, retrospective design; results depend on the specific ARR thresholds and assay used at this referral center, which may not generalize to other laboratories or cutoffs.
Two concordant positive ARR tests gave the best diagnostic accuracy for primary aldosteronism, while discordant results needed further work-up.
This is an AI-generated summary of the published abstract, not a clinical recommendation. It may not reflect the full text or subsequent updates — verify against the original source before acting on it.
Abstract
Context
Guidelines recommend repeating aldosterone-to-renin ratio (ARR) testing when clinical suspicion of primary aldosteronism (PA) remains high, but evidence-based guidance on how serial ARR measurements should be interpreted is lacking.
Objective
To compare alternative strategies for interpreting serial ARR measurements during the diagnostic work-up of PA.
Methods
We retrospectively studied patients evaluated for PA at a referral centre for endocrine hypertension who had two valid ARR measurements. Diagnostic performance was compared for ARR1, the mean of ARR1 and ARR2, at least one positive ARR, and two concordant positive ARR results using different thresholds. Additional analyses evaluated concordant and discordant patterns and progressively more stringent biochemical definitions.
Results
Among 342 patients with two serial ARR measurements, 214 (62.6%) had PA. Different interpretation strategies produced distinct trade-offs between sensitivity and specificity. At an ARR threshold of 49, requiring both measurements to be positive achieved the highest balanced accuracy (77.1%), with 82.2% sensitivity and 71.9% specificity. PA prevalence increased from 21.3% in patients with two negative ARR measurements to 83.0% in those with two positive measurements, whereas both discordant patterns showed an intermediate probability of PA (36.8% and 36.0%). Averaging the first two ARR measurements modestly improved discrimination across progressively more stringent operational biochemical definitions, with the AUC increasing from 0.772 to 0.803 for ARR ≥49 plus post-SST SAC ≥100 ng/L (p = 0.015).
Conclusions
Serial ARR measurements provide complementary rather than interchangeable information. Different interpretation strategies offer distinct diagnostic trade-offs, whereas discordant results identify an intermediate-probability group requiring integration with the overall clinical context.
DOI
10.1210/clinem/dgag381
PMID
42745422
Research metadata (titles, abstracts, authors, publication dates) is sourced from Europe PMC, which aggregates content from PubMed/MEDLINE, PubMed Central, and other providers under the U.S. National Library of Medicine (NLM/NCBI). NLM does not claim copyright on abstracts; the original journal publishers or authors may hold rights to the full articles. AI-generated summaries are derived only from the abstract, never the full text, and are always labeled as AI-generated.
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