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Assays of the renin-angiotensin-aldosterone system in adrenal disease

Michael Stowasser, MD
Section Editor
André Lacroix, MD
Deputy Editor
Kathryn A Martin, MD


Assessment of the renin-angiotensin-aldosterone system has recently assumed a much greater role in clinical practice, particularly in the evaluation of patients with hypertension. This is mainly attributable to the growing appreciation that primary aldosteronism is a much more common cause of hypertension than previously thought, accounting for as many as 5 to 10 percent of cases, and that most patients lack hypokalemia as a clinical clue. As a result, guidelines advocate screening for primary aldosteronism by measurement of the plasma aldosterone/renin ratio rather than that of plasma potassium (which is much less sensitive) and among a much wider population of hypertensives than previously [1].

In addition, the renin-angiotensin-aldosterone system is often evaluated in patients with:

Hypokalemia or hyperkalemia who may have hyperaldosteronism (or other forms of real or apparent mineralocorticoid excess) or hypoaldosteronism, respectively

Adrenal insufficiency (to distinguish primary from secondary)

The use of renin, angiotensin, and aldosterone measurements will be reviewed here. The approach to the patient with potential mineralocorticoid excess or hypoaldosteronism is discussed separately. (See "Diagnosis of primary aldosteronism" and "Causes and evaluation of hyperkalemia in adults".)

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Literature review current through: Sep 2017. | This topic last updated: May 19, 2017.
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