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Obesity and the diagnostic accuracy for primary aldosteronism
Amit Tirosh1,2, Fady Hannah-Shmouni1, Charalampos Lyssikatos1
1Section on Endocrinology and Genetics, Eunice Kennedy Shriver National Institute of Child Health and Human Development, National Institutes of Health, Bethesda, MD, USA.
Journal of Clinical Hypertension (Greenwich, Conn.)
|June 15, 2017
Summary
Obesity impacts primary aldosteronism (PA) diagnosis accuracy. Body mass index shows a U-shaped correlation with key hormone levels, affecting PA case detection, especially in obese patients.
Area of Science:
- Endocrinology
- Clinical Diagnostics
Background:
- Obesity and hypertension frequently co-occur with primary aldosteronism (PA).
- The influence of body mass index (BMI) on PA diagnostic accuracy remains unclear.
Purpose of the Study:
- To investigate the correlation between BMI and diagnostic markers of PA.
- To evaluate the impact of BMI on the accuracy of PA diagnosis.
Main Methods:
- 59 adult patients underwent stepwise PA evaluation.
- Aldosterone-to-renin ratio (ARR) for case detection.
- Plasma aldosterone concentration (PAC) post-saline suppression test and/or 24-hour urinary aldosterone post-sodium loading for confirmation.
Main Results:
- BMI exhibited a quadratic (U-shaped) correlation with PAC, plasma renin activity (PRA), ARR, and post-saline PAC.
- ARR showed reduced PA case detection accuracy in patients with BMI ≥30 kg/m².
- Obesity negatively impacted the accuracy of PA case confirmation tests.
Conclusions:
- Obesity is associated with a nonlinear relationship between BMI and hormonal markers (PAC, PRA, ARR).
- This nonlinear relationship affects the accuracy of PA case detection.
- Diagnostic tests for PA may be less accurate in obese individuals (BMI ≥30 kg/m²).
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