Interpreting serial aldosterone-to-renin ratio measurements in the diagnostic work-up of primary aldosteronism
Authors' conclusion
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.
Study context
- Population
- Patients evaluated for primary aldosteronism (PA) at a referral centre for endocrine hypertension with two valid aldosterone-to-renin ratio (ARR) measurements214 (62.6%) had PA
- Participants
- 342 patients
- Comparison
- Alternative strategies for interpreting serial ARR measurements
- Outcome
- Diagnostic performance of ARR interpretation strategies for PA
Methodological detailssingle referral centre
- Single referral centre
Performance
As reported in the abstract
Diagnostic performance at ARR threshold of 49
| Test or model | Balanced accuracy | Sensitivity | Specificity |
|---|---|---|---|
| Two concordant positive ARR | 77.1% | 82.2% | 71.9% |
Two concordant positive ARR
Balanced accuracy77.1%
Sensitivity82.2%
Specificity71.9%
Further findings
| Outcome | AUC | P value |
|---|---|---|
| AUC across more stringent biochemical definitions (ARR ≥49 plus post-SST SAC ≥100 ng/L)Mean of ARR1 and ARR2 vs ARR1 | 0.803 vs 0.772 | P = 0.015 |
PA prevalence by ARR pattern
- PA prevalence, two negative ARR
- 21.3%
- PA prevalence, two positive ARR
- 83.0%
- PA prevalence, discordant patterns (intermediate probability)
- 36.8% and 36.0%
AUC across more stringent biochemical definitions (ARR ≥49 plus post-SST SAC ≥100 ng/L)
- Averaging the first two ARR measurements modestly improved discrimination
Original publication
Interpreting serial aldosterone-to-renin ratio measurements in the diagnostic work-up of primary aldosteronism. J Clin Endocrinol Metab. Published 16 September 2026. doi:10.
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