Aldosterone

Hormone/ Element

Report in 48Hrs

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No Fasting Required

Details

Hormone regulating sodium & potassium; blood test.

₹2,590₹3,700

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Aldosterone Test Information Guide

Why is it done?
- Measures the level of aldosterone, a hormone produced by the adrenal glands that regulates sodium and potassium balance and blood pressure
- Evaluate patients with uncontrolled or resistant hypertension to detect primary aldosteronism
- Investigate abnormal potassium levels (hypokalemia or hyperkalemia)
- Assess adrenal insufficiency or Addison's disease with low aldosterone levels
- Diagnose secondary hypertension caused by aldosterone overproduction (Conn syndrome)
- Monitor patients with heart failure, cirrhosis, or nephrotic syndrome
- Typically performed in outpatient clinical settings when electrolyte abnormalities or hypertension warrant investigation
Normal Range
- Plasma Aldosterone (Seated Position): 4-31 pg/mL or 11-86 pmol/L (normal range varies by laboratory and patient position)
- Plasma Aldosterone (Upright Position - 2 hours): 7-52 pg/mL or 19-144 pmol/L (higher values in upright position)
- 24-Hour Urinary Aldosterone: 6-25 mcg/24 hours (reference values vary by laboratory)
- Normal results indicate appropriate aldosterone regulation, adequate adrenal function, and proper sodium-potassium balance
- High aldosterone with low renin activity suggests primary aldosteronism (Conn syndrome)
- Low aldosterone may indicate adrenal insufficiency, particularly when accompanied by elevated renin
- Reference ranges vary significantly by laboratory, testing method, and patient position; always interpret with specific lab reference values
Interpretation
- Elevated Aldosterone (>15 ng/dL with suppressed renin): Suggests primary aldosteronism; aldosterone-to-renin ratio (ARR) >20-30 is diagnostic; indicates unilateral or bilateral adrenal adenomas or bilateral hyperplasia; may cause resistant hypertension and hypokalemia
- Elevated Aldosterone with Elevated Renin: Indicates secondary aldosteronism due to renal hypoperfusion; seen in heart failure, cirrhosis, nephrotic syndrome, or renovascular hypertension; renal-angiotensin system is appropriately responding to volume depletion
- Low Aldosterone (<4 pg/mL): Suggests adrenal insufficiency or Addison's disease; may accompany elevated renin indicating primary adrenal dysfunction; can cause hyperkalemia and low sodium
- Aldosterone-to-Renin Ratio (ARR): Ratio >20-30 with suppressed plasma renin activity strongly suggests primary aldosteronism; helps differentiate primary from secondary causes
- Factors Affecting Results: Patient position (seated vs upright affects values); time of day (diurnal variation); medications (ACE inhibitors, ARBs, potassium-sparing diuretics, NSAIDs); sodium intake; pregnancy; menstrual cycle; stress and illness; recent exercise
- Confirmatory Tests: If elevated aldosterone suspected, perform saline suppression test or captopril challenge test; elevated aldosterone that fails to suppress with sodium loading confirms autonomous aldosterone production
Associated Organs
- Primary Organs Involved: Adrenal glands (zona glomerulosa produces aldosterone); kidneys (aldosterone acts on collecting duct to increase sodium and water reabsorption); heart and blood vessels (aldosterone causes vasoconstriction and fibrosis)
- Disorders Associated with High Aldosterone: Primary aldosteronism (Conn syndrome - adenoma or hyperplasia); secondary aldosteronism (heart failure, cirrhosis, nephrotic syndrome, renovascular hypertension); renal artery stenosis; pregnancy; dehydration; hypokalemia
- Disorders Associated with Low Aldosterone: Addison's disease (adrenal insufficiency); autoimmune adrenalitis; adrenal hemorrhage or necrosis; tuberculosis of adrenal glands; infections; critical illness; type 4 renal tubular acidosis; congenital adrenal hyperplasia
- Complications of Abnormal Aldosterone: High levels: Uncontrolled hypertension, cardiac arrhythmias from hypokalemia, cardiac fibrosis, myocardial infarction, stroke, left ventricular hypertrophy, kidney disease progression; Low levels: Severe hypotension, hyperkalemia, cardiac dysrhythmias, circulatory collapse, adrenal crisis
- System Effects: Cardiovascular: hypertension, left ventricular hypertrophy, atrial fibrillation, myocardial fibrosis; Renal: proteinuria, albuminuria, progressive nephropathy; Metabolic: electrolyte imbalances, metabolic alkalosis; Endocrine: affects renin-angiotensin-aldosterone system (RAAS)
Follow-up Tests
- If Elevated Aldosterone Suspected: Plasma renin activity (PRA) or direct renin concentration (DRC); aldosterone-to-renin ratio (ARR); saline suppression test (IV normal saline infusion); oral sodium loading test; captopril challenge test; 24-hour urinary potassium and sodium
- Confirmatory Imaging Studies: Abdominal CT scan or MRI to identify adrenal adenoma or bilateral hyperplasia; adrenal venous sampling (AVS) to determine unilateral vs bilateral disease; renal artery duplex ultrasound if renovascular hypertension suspected
- If Low Aldosterone Suspected: Plasma renin activity (elevated in adrenal insufficiency); ACTH stimulation test (cosyntropin test); cortisol level (often low with aldosterone); electrolytes (potassium, sodium); blood glucose; imaging of adrenal glands (CT/MRI); tuberculin skin test if TB adrenalitis suspected
- Routine Monitoring and Related Tests: Electrolyte panel (sodium, potassium, chloride, bicarbonate); blood pressure monitoring; renal function tests (creatinine, eGFR); echocardiography to assess cardiac effects; ECG for arrhythmias from electrolyte abnormalities
- Monitoring Frequency: Initial: Repeat aldosterone and renin within 2-4 weeks if initial results borderline; Ongoing: Monitor aldosterone annually if diagnosed with primary aldosteronism on treatment; electrolytes every 3-6 months with therapy changes; blood pressure regularly; follow-up imaging based on imaging findings
- Complementary Testing: Angiotensin II level; 11-deoxycortisol; 17-hydroxyprogesterone (if congenital adrenal hyperplasia suspected); urinary metanephrines (to exclude pheochromocytoma if hypertensive); other adrenal hormone panels
Fasting Required?
- Fasting Status: No, fasting is NOT required for aldosterone testing
- Pre-Test Patient Instructions: Patient should maintain normal sodium diet (typically 100-200 mEq/day) for 2-4 weeks prior to testing unless otherwise directed; maintain normal hydration status; avoid excessive salt restriction or salt loading; remain ambulatory for at least 2 hours before blood draw if upright position values needed
- Medications to Avoid or Discuss: ACE inhibitors (lisinopril, enalapril) - discontinue 4-6 weeks prior if possible; Angiotensin II receptor blockers (losartan, valsartan) - discontinue 4-6 weeks prior; Potassium-sparing diuretics (spironolactone, amiloride) - discontinue 4-6 weeks prior; NSAIDs - discontinue 1-2 weeks prior; Diuretics (may affect results) - discuss with physician; Decongestants with pseudoephedrine - discontinue before testing; Oral contraceptives - may increase aldosterone; Licorice - can elevate aldosterone
- Timing Considerations: Obtain blood samples in morning (8-10 AM) due to diurnal variation with higher levels later in day; if upright position measurement needed, patient should be upright for at least 2 hours prior to draw; schedule tests consistently at same time for comparison; avoid excessive physical stress or emotional stress immediately before testing
- Other Preparation Requirements: Restrict physical activity for 30 minutes before blood draw; sit quietly for 5-10 minutes before collection; inform laboratory of medications being taken; blood sample should be drawn into appropriate tube (usually EDTA or SST per lab protocol); plasma samples require immediate refrigeration and processing; avoid prolonged tourniquet application; patient should not strain during needle insertion; document patient position (seated vs upright) at time of draw

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