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Effect of Contraceptives on Aldosterone/Renin Ratio May Vary According to the Components of Contraceptive, Renin Assay Method, and Possibly Route of Administration

Calculating the aldosterone/renin ratio using plasma renin activity is preferable, and possibly more reliable, than using direct renin concentration. Background: The most popular screening test for primary aldosteronism is plasma aldosterone/renin ratio (ARR). Because both estrogen and progesterone... Full description

Journal Title: The journal of clinical endocrinology and metabolism 2011, Vol.96 (6), p.1797-1804
Main Author: Ahmed, Ashraf H
Other Authors: Gordon, Richard D , Taylor, Paul J , Ward, Gregory , Pimenta, Eduardo , Stowasser, Michael
Format: Electronic Article Electronic Article
Language: English
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Publisher: Bethesda, MD: Endocrine Society
ID: ISSN: 0021-972X
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title: Effect of Contraceptives on Aldosterone/Renin Ratio May Vary According to the Components of Contraceptive, Renin Assay Method, and Possibly Route of Administration
format: Article
creator:
  • Ahmed, Ashraf H
  • Gordon, Richard D
  • Taylor, Paul J
  • Ward, Gregory
  • Pimenta, Eduardo
  • Stowasser, Michael
subjects:
  • Abridged Index Medicus
  • Adult
  • Aldosterone - blood
  • Androstenes - pharmacology
  • Biological and medical sciences
  • Blood Pressure - drug effects
  • Chromatography, High Pressure Liquid
  • Endocrinopathies
  • Estradiol - blood
  • Ethinyl Estradiol - pharmacology
  • Feeding. Feeding behavior
  • Female
  • Follicle Stimulating Hormone - blood
  • Fundamental and applied biological sciences. Psychology
  • Humans
  • Hydrocortisone - blood
  • Immunoassay
  • Luteinizing Hormone - blood
  • Medical sciences
  • Progesterone - blood
  • Renin - blood
  • Reproductive Control Agents - pharmacology
  • Tandem Mass Spectrometry
  • Vertebrates: anatomy and physiology, studies on body, several organs or systems
  • Vertebrates: endocrinology
ispartof: The journal of clinical endocrinology and metabolism, 2011, Vol.96 (6), p.1797-1804
description: Calculating the aldosterone/renin ratio using plasma renin activity is preferable, and possibly more reliable, than using direct renin concentration. Background: The most popular screening test for primary aldosteronism is plasma aldosterone/renin ratio (ARR). Because both estrogen and progesterone affect aldosterone and renin levels, we studied effects of two contraceptives commonly used in our population, one oral and one subdermal, on ARR, measuring renin as both direct renin concentration (DRC) and plasma renin activity (PRA). Methods: Normotensive, healthy women underwent measurement (seated, midmorning) of plasma aldosterone, DRC, PRA, electrolytes, and creatinine and urinary aldosterone, cortisol, electrolytes, and creatinine at baseline (menses) and after either 1) 3 wk treatment with oral ethinylestradiol plus drospirenone (n = 17) or 2) 1 wk and 6 wk treatment with subdermal etonogestrel (n = 15), a third-generation progestin. Results: Treatment with oral ethinylestradiol plus drospirenone was associated with significant increases in aldosterone [median (range) at baseline = 131 (85–590) pmol/liter; at 1 wk, 200 (130–784) pmol/liter; and at 3 wk, 412 (199–1010) pmol/liter (P < 0.001, Friedman test)] and PRA [2.1 (1.2–4.7), 3.6 (1.5–7.1), and 4.9 (1.5–10.8) ng/ml · h, P < 0.001] but decreases in DRC [22 (11–36), 21 (8.7–41), and 14 (8.5–39) mU/liter, P < 0.01] leading to increases in ARR calculated by DRC [6.6 (3.3–31.3), 10.9 (5.2–58.9), and 29.8 (5.1–88.5), P < 0.001]. There were no significant changes in ARR calculated by PRA, plasma electrolytes and creatinine, and all urinary measurements. In contrast, treatment with subdermal etonogestrel was associated with no significant changes in PRA, DRC, aldosterone, or ARR at either 1 or 6 wk. Conclusion: The combined oral contraceptive ethinylestradiol plus drospirenone is capable of significantly increasing ARR with risk of false-positive results during screening for primary aldosteronism, but only if DRC is used to calculate the ratio. Subdermal etonogestrel had no effect on ARR after 6 wk.
language: eng
source:
identifier: ISSN: 0021-972X
fulltext: no_fulltext
issn:
  • 0021-972X
  • 1945-7197
url: Link


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titleEffect of Contraceptives on Aldosterone/Renin Ratio May Vary According to the Components of Contraceptive, Renin Assay Method, and Possibly Route of Administration
creatorAhmed, Ashraf H ; Gordon, Richard D ; Taylor, Paul J ; Ward, Gregory ; Pimenta, Eduardo ; Stowasser, Michael
creatorcontribAhmed, Ashraf H ; Gordon, Richard D ; Taylor, Paul J ; Ward, Gregory ; Pimenta, Eduardo ; Stowasser, Michael
descriptionCalculating the aldosterone/renin ratio using plasma renin activity is preferable, and possibly more reliable, than using direct renin concentration. Background: The most popular screening test for primary aldosteronism is plasma aldosterone/renin ratio (ARR). Because both estrogen and progesterone affect aldosterone and renin levels, we studied effects of two contraceptives commonly used in our population, one oral and one subdermal, on ARR, measuring renin as both direct renin concentration (DRC) and plasma renin activity (PRA). Methods: Normotensive, healthy women underwent measurement (seated, midmorning) of plasma aldosterone, DRC, PRA, electrolytes, and creatinine and urinary aldosterone, cortisol, electrolytes, and creatinine at baseline (menses) and after either 1) 3 wk treatment with oral ethinylestradiol plus drospirenone (n = 17) or 2) 1 wk and 6 wk treatment with subdermal etonogestrel (n = 15), a third-generation progestin. Results: Treatment with oral ethinylestradiol plus drospirenone was associated with significant increases in aldosterone [median (range) at baseline = 131 (85–590) pmol/liter; at 1 wk, 200 (130–784) pmol/liter; and at 3 wk, 412 (199–1010) pmol/liter (P < 0.001, Friedman test)] and PRA [2.1 (1.2–4.7), 3.6 (1.5–7.1), and 4.9 (1.5–10.8) ng/ml · h, P < 0.001] but decreases in DRC [22 (11–36), 21 (8.7–41), and 14 (8.5–39) mU/liter, P < 0.01] leading to increases in ARR calculated by DRC [6.6 (3.3–31.3), 10.9 (5.2–58.9), and 29.8 (5.1–88.5), P < 0.001]. There were no significant changes in ARR calculated by PRA, plasma electrolytes and creatinine, and all urinary measurements. In contrast, treatment with subdermal etonogestrel was associated with no significant changes in PRA, DRC, aldosterone, or ARR at either 1 or 6 wk. Conclusion: The combined oral contraceptive ethinylestradiol plus drospirenone is capable of significantly increasing ARR with risk of false-positive results during screening for primary aldosteronism, but only if DRC is used to calculate the ratio. Subdermal etonogestrel had no effect on ARR after 6 wk.
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subjectAbridged Index Medicus ; Adult ; Aldosterone - blood ; Androstenes - pharmacology ; Biological and medical sciences ; Blood Pressure - drug effects ; Chromatography, High Pressure Liquid ; Endocrinopathies ; Estradiol - blood ; Ethinyl Estradiol - pharmacology ; Feeding. Feeding behavior ; Female ; Follicle Stimulating Hormone - blood ; Fundamental and applied biological sciences. Psychology ; Humans ; Hydrocortisone - blood ; Immunoassay ; Luteinizing Hormone - blood ; Medical sciences ; Progesterone - blood ; Renin - blood ; Reproductive Control Agents - pharmacology ; Tandem Mass Spectrometry ; Vertebrates: anatomy and physiology, studies on body, several organs or systems ; Vertebrates: endocrinology
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2Taylor, Paul J
3Ward, Gregory
4Pimenta, Eduardo
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0Effect of Contraceptives on Aldosterone/Renin Ratio May Vary According to the Components of Contraceptive, Renin Assay Method, and Possibly Route of Administration
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descriptionCalculating the aldosterone/renin ratio using plasma renin activity is preferable, and possibly more reliable, than using direct renin concentration. Background: The most popular screening test for primary aldosteronism is plasma aldosterone/renin ratio (ARR). Because both estrogen and progesterone affect aldosterone and renin levels, we studied effects of two contraceptives commonly used in our population, one oral and one subdermal, on ARR, measuring renin as both direct renin concentration (DRC) and plasma renin activity (PRA). Methods: Normotensive, healthy women underwent measurement (seated, midmorning) of plasma aldosterone, DRC, PRA, electrolytes, and creatinine and urinary aldosterone, cortisol, electrolytes, and creatinine at baseline (menses) and after either 1) 3 wk treatment with oral ethinylestradiol plus drospirenone (n = 17) or 2) 1 wk and 6 wk treatment with subdermal etonogestrel (n = 15), a third-generation progestin. Results: Treatment with oral ethinylestradiol plus drospirenone was associated with significant increases in aldosterone [median (range) at baseline = 131 (85–590) pmol/liter; at 1 wk, 200 (130–784) pmol/liter; and at 3 wk, 412 (199–1010) pmol/liter (P < 0.001, Friedman test)] and PRA [2.1 (1.2–4.7), 3.6 (1.5–7.1), and 4.9 (1.5–10.8) ng/ml · h, P < 0.001] but decreases in DRC [22 (11–36), 21 (8.7–41), and 14 (8.5–39) mU/liter, P < 0.01] leading to increases in ARR calculated by DRC [6.6 (3.3–31.3), 10.9 (5.2–58.9), and 29.8 (5.1–88.5), P < 0.001]. There were no significant changes in ARR calculated by PRA, plasma electrolytes and creatinine, and all urinary measurements. In contrast, treatment with subdermal etonogestrel was associated with no significant changes in PRA, DRC, aldosterone, or ARR at either 1 or 6 wk. Conclusion: The combined oral contraceptive ethinylestradiol plus drospirenone is capable of significantly increasing ARR with risk of false-positive results during screening for primary aldosteronism, but only if DRC is used to calculate the ratio. Subdermal etonogestrel had no effect on ARR after 6 wk.
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0Abridged Index Medicus
1Adult
2Aldosterone - blood
3Androstenes - pharmacology
4Biological and medical sciences
5Blood Pressure - drug effects
6Chromatography, High Pressure Liquid
7Endocrinopathies
8Estradiol - blood
9Ethinyl Estradiol - pharmacology
10Feeding. Feeding behavior
11Female
12Follicle Stimulating Hormone - blood
13Fundamental and applied biological sciences. Psychology
14Humans
15Hydrocortisone - blood
16Immunoassay
17Luteinizing Hormone - blood
18Medical sciences
19Progesterone - blood
20Renin - blood
21Reproductive Control Agents - pharmacology
22Tandem Mass Spectrometry
23Vertebrates: anatomy and physiology, studies on body, several organs or systems
24Vertebrates: endocrinology
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titleEffect of Contraceptives on Aldosterone/Renin Ratio May Vary According to the Components of Contraceptive, Renin Assay Method, and Possibly Route of Administration
authorAhmed, Ashraf H ; Gordon, Richard D ; Taylor, Paul J ; Ward, Gregory ; Pimenta, Eduardo ; Stowasser, Michael
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abstractCalculating the aldosterone/renin ratio using plasma renin activity is preferable, and possibly more reliable, than using direct renin concentration. Background: The most popular screening test for primary aldosteronism is plasma aldosterone/renin ratio (ARR). Because both estrogen and progesterone affect aldosterone and renin levels, we studied effects of two contraceptives commonly used in our population, one oral and one subdermal, on ARR, measuring renin as both direct renin concentration (DRC) and plasma renin activity (PRA). Methods: Normotensive, healthy women underwent measurement (seated, midmorning) of plasma aldosterone, DRC, PRA, electrolytes, and creatinine and urinary aldosterone, cortisol, electrolytes, and creatinine at baseline (menses) and after either 1) 3 wk treatment with oral ethinylestradiol plus drospirenone (n = 17) or 2) 1 wk and 6 wk treatment with subdermal etonogestrel (n = 15), a third-generation progestin. Results: Treatment with oral ethinylestradiol plus drospirenone was associated with significant increases in aldosterone [median (range) at baseline = 131 (85–590) pmol/liter; at 1 wk, 200 (130–784) pmol/liter; and at 3 wk, 412 (199–1010) pmol/liter (P < 0.001, Friedman test)] and PRA [2.1 (1.2–4.7), 3.6 (1.5–7.1), and 4.9 (1.5–10.8) ng/ml · h, P < 0.001] but decreases in DRC [22 (11–36), 21 (8.7–41), and 14 (8.5–39) mU/liter, P < 0.01] leading to increases in ARR calculated by DRC [6.6 (3.3–31.3), 10.9 (5.2–58.9), and 29.8 (5.1–88.5), P < 0.001]. There were no significant changes in ARR calculated by PRA, plasma electrolytes and creatinine, and all urinary measurements. In contrast, treatment with subdermal etonogestrel was associated with no significant changes in PRA, DRC, aldosterone, or ARR at either 1 or 6 wk. Conclusion: The combined oral contraceptive ethinylestradiol plus drospirenone is capable of significantly increasing ARR with risk of false-positive results during screening for primary aldosteronism, but only if DRC is used to calculate the ratio. Subdermal etonogestrel had no effect on ARR after 6 wk.
copBethesda, MD
pubEndocrine Society
pmid21411552
doi10.1210/jc.2010-2918
oafree_for_read