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22177 Aldosterone, Serum (ALDS)

Aldosterone, Serum (ALDS)
Test Code: ALDSSO
Useful For
Investigation of primary aldosteronism (eg, adrenal adenoma/carcinoma and adrenal cortical hyperplasia) and secondary aldosteronism (renovascular disease, salt depletion, potassium loading, cardiac failure with ascites, pregnancy, Bartter syndrome).
Specimen Requirements
Fasting Required Specimen Type Preferred Container/Tube Acceptable Container/Tube Specimen Volume Specimen Minimum Volume
(allows for 1 repeat)		 Pediatric Minimum Volume
(no repeat)
No​ Serum​ Red Top Tube (RTT)​ ​Serum Separator Tube (SST) 1.2 mL​ 1.2 mL
Collection Processing Instructions
8 a.m. draw time (after the patient is active for 2 hours) is recommended; preferably no later than 10 a.m.
Specimen Stability Information
Specimen Type Temperature Time
Serum​ Refrigerated  (preferred)​ 28 days​ ​
Frozen 30 days​
​Ambient ​4 days
Interference

The plasma renin activity (PRA) cannot be interpreted if the patient is being treated with spironolactone (Aldactone). Spironolactone should be discontinued for 4 to 6 weeks before testing.

Late p.m. levels can be up to 30% lower than early a.m. levels. Supine values are on average 50% lower than upright collections. Sodium deplete subjects have significantly elevated serum aldosterone (SA) levels, potentially exceeding the upper limit of the salt replete upright reference range by several fold. To account for these variables, at least in part, it is recommended that PRA is measured concomitantly. In situations of physiological variability, PRA should be altered in the same direction as aldosterone. See Mayo Labs Renin-Aldosterone Studies in Special Instructions.

Angiotensin converting enzyme (ACE) inhibitors have the potential to falsely elevate PRA. Therefore, in a patient treated with an ACE inhibitor, the findings of a detectable PRA level or a low SA/PRA ratio do not exclude the diagnosis of primary aldosteronism. In addition, a strong predictor for primary aldosteronism is a PRA level undetectably low in a patient taking an ACE inhibitor. 

Performing Laboratory Information
Performing Location Day(s) Test Performed Report Available Methodology/Instrumentation
Mayo Clinic Laboratories Monday​ through Friday 2 to 5 days Liquid Chromatography-Tandem Mass Spectrometry (LC-MS/MS)
Reference Lab
Mayo Clinic Laboratories
Reference Range Information
Performing Location Reference Range
Mayo Clinic Laboratories
0-30 days: 17-154 ng/dL*
31 days-11 months: 6.5-86 ng/dL*
1-10 years:
< or =40 ng/dL (supine)*
< or =124 ng/dL (upright)*
> or =11 years: < or =21 ng/dL (a.m. peripheral vein specimen)
 
*Loeuille GA, Racadot A, Vasseur P, Vandewalle B: Blood and urinary aldosterone levels in normal neonates, infants and children. Pediatrie 1981;36:335-344
Interpretation
A high ratio of serum aldosterone (SA) in ng/dL to plasma renin activity (PRA) in ng/mL per hour, is a positive screening test result, a finding that warrants further testing. An SA/PRA ratio > or =20 is only interpretable with an SA > or =15 ng/dL and indicates probable primary aldosteronism.
 
Renal disease, such as unilateral renal artery stenosis, results in elevated renin and aldosterone levels. Renal venous catheterization may be helpful. A positive test is a renal venous renin ratio (affected/normal) >1.5.
 
See Renin-Aldosterone Studies and Steroid Pathways in Special Instructions.
 
Note: Advice on stimulation or suppression tests is available from Mayo Clinic's Division of Endocrinology and may be obtained by calling Mayo Medical Laboratories
Outreach CPTs
CPT Modifier
(if needed)		 Quantity Description Comments
82088 ​ ​ ​ ​ ​
Classification
​
Ordering Applications
Ordering Application Description
​Cerner ​Aldosterone, Serum (ALDS)
​COM ​Aldosterone, Serum (ALDS)
If the ordering application you are looking for is not listed, contact your local laboratory for assistance.
Specimen Requirements
Fasting Required Specimen Type Preferred Container/Tube Acceptable Container/Tube Specimen Volume Specimen Minimum Volume
(allows for 1 repeat)		 Pediatric Minimum Volume
(no repeat)
No​ Serum​ Red Top Tube (RTT)​ ​Serum Separator Tube (SST) 1.2 mL​ 1.2 mL
Collection Processing
8 a.m. draw time (after the patient is active for 2 hours) is recommended; preferably no later than 10 a.m.
Specimen Stability Information
Specimen Type Temperature Time
Serum​ Refrigerated  (preferred)​ 28 days​ ​
Frozen 30 days​
​Ambient ​4 days
Interference

The plasma renin activity (PRA) cannot be interpreted if the patient is being treated with spironolactone (Aldactone). Spironolactone should be discontinued for 4 to 6 weeks before testing.

Late p.m. levels can be up to 30% lower than early a.m. levels. Supine values are on average 50% lower than upright collections. Sodium deplete subjects have significantly elevated serum aldosterone (SA) levels, potentially exceeding the upper limit of the salt replete upright reference range by several fold. To account for these variables, at least in part, it is recommended that PRA is measured concomitantly. In situations of physiological variability, PRA should be altered in the same direction as aldosterone. See Mayo Labs Renin-Aldosterone Studies in Special Instructions.

Angiotensin converting enzyme (ACE) inhibitors have the potential to falsely elevate PRA. Therefore, in a patient treated with an ACE inhibitor, the findings of a detectable PRA level or a low SA/PRA ratio do not exclude the diagnosis of primary aldosteronism. In addition, a strong predictor for primary aldosteronism is a PRA level undetectably low in a patient taking an ACE inhibitor. 

Useful For
Investigation of primary aldosteronism (eg, adrenal adenoma/carcinoma and adrenal cortical hyperplasia) and secondary aldosteronism (renovascular disease, salt depletion, potassium loading, cardiac failure with ascites, pregnancy, Bartter syndrome).
Reference Range Information
Performing Location Reference Range
Mayo Clinic Laboratories
0-30 days: 17-154 ng/dL*
31 days-11 months: 6.5-86 ng/dL*
1-10 years:
< or =40 ng/dL (supine)*
< or =124 ng/dL (upright)*
> or =11 years: < or =21 ng/dL (a.m. peripheral vein specimen)
 
*Loeuille GA, Racadot A, Vasseur P, Vandewalle B: Blood and urinary aldosterone levels in normal neonates, infants and children. Pediatrie 1981;36:335-344
Interpretation
A high ratio of serum aldosterone (SA) in ng/dL to plasma renin activity (PRA) in ng/mL per hour, is a positive screening test result, a finding that warrants further testing. An SA/PRA ratio > or =20 is only interpretable with an SA > or =15 ng/dL and indicates probable primary aldosteronism.
 
Renal disease, such as unilateral renal artery stenosis, results in elevated renin and aldosterone levels. Renal venous catheterization may be helpful. A positive test is a renal venous renin ratio (affected/normal) >1.5.
 
See Renin-Aldosterone Studies and Steroid Pathways in Special Instructions.
 
Note: Advice on stimulation or suppression tests is available from Mayo Clinic's Division of Endocrinology and may be obtained by calling Mayo Medical Laboratories
For more information visit:
Performing Laboratory Information
Performing Location Day(s) Test Performed Report Available Methodology/Instrumentation
Mayo Clinic Laboratories Monday​ through Friday 2 to 5 days Liquid Chromatography-Tandem Mass Spectrometry (LC-MS/MS)
Reference Lab
Mayo Clinic Laboratories
For billing questions, see Contacts
Outreach CPTs
CPT Modifier
(if needed)		 Quantity Description Comments
82088 ​ ​ ​ ​ ​
Classification
​
For most current information refer to the Marshfield Laboratory online reference manual.