What is the postural test protocol for primary aldosteronism?

Updated: Mar 24, 2020
  • Author: Gabriel I Uwaifo, MD; Chief Editor: Romesh Khardori, MD, PhD, FACP  more...
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Answer

The standard postural test protocol involves obtaining baseline values for serum aldosterone (S-Aldo) and plasma renin activity (PRA) levels, as well as these levels 2 hours after the patient has assumed an erect posture. S-Aldo levels typically rise in this setting at least 50% above baseline in healthy persons, in persons with essential HTN, and in the subgroup of patients with primary aldosteronism who have either idiopathic adrenal hyperplasia (IAH) or RRAs.

Among patients with aldosteronomas (aldosterone-producing adenomas; APAs), S-Aldo levels typically do not rise or paradoxically fall to this level. The sensitivity and specificity of this test in the differential diagnosis of the main causes of primary aldosteronism have been reported to be as high as 80-85%.


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