In defense of aldosterone measurement by immunoassay: a broader perspective

Blocki, Frank; Zierold, Claudia; Olson, Greg R.; Seeman, Jeremy; Cummings, Steve; Bonelli, Fabrizio

doi:10.1515/cclm-2016-0707

Cited by 5 publications

(4 citation statements)

References 8 publications

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“…Furthermore, the present study showed that PAC determined via CLIA was higher than that determined via LC-MS/MS analysis, which was consistent with previous findings [ 23 , 37 , 38 ]. One possible reason is that LC-MS/MS only detects aldosterone in plasma, while CLIA detects total aldosterone including aldosterone and aldosterone 3C-glucuronide [ 39 ]. Therefore, CLIA assay may be better to reveal pathological concentrations of aldosterone against which clinical decisions are based.…”

Section: Discussionmentioning

confidence: 99%

Comparison of plasma aldosterone measured by chemiluminescence immunoassay and liquid chromatography-tandem mass spectrometry in screening test for primary aldosteronism

Chen,

Lai,

Huang

et al. 2024

Practical Laboratory Medicine

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Section: Discussionmentioning

confidence: 99%

Comparison of plasma aldosterone measured by chemiluminescence immunoassay and liquid chromatography-tandem mass spectrometry in screening test for primary aldosteronism

Chen,

Lai,

Huang

et al. 2024

Practical Laboratory Medicine

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“…Since the CLIA is based on the antigen-antibody reaction, interference from non-speci c reactions and cross-reactivity are inevitable. The aldosterone concentration detected by CLIA is the sum of the aldosterone and its metabolites, such as aldosterone 3C-glucuronide, due to the lack of antibody speci city [14]. Aldosterone 3C-glucuronide is present in normal human serum and excreted in the urine.…”

Section: Discussionmentioning

confidence: 99%

Comparison of chemiluminescence immunoassay with LC-MS/MS in the determination of plasma aldosterone concentration in patients with declined renal function

Zeng,

Li,

Yang

et al. 2024

Preprint

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Purpose Compared with chemiluminescence immunoassay (CLIA), quantification of plasma aldosterone concentration (PAC) by liquid chromatography-tandem mass spectrometry (LC-MS/MS) yields lower values. Whether this difference is exacerbated by a declined glomerular filtration rate (eGFR) is unclear. Therefore, this study aims to assess the impact of renal insufficiency on PAC measured by CLIA using LC-MS/MS as the reference method. Methods In subjects with normal or declined estimated glomerular filtration rate (eGFR), PAC were measured by both LC-MS/MS and two different CLIA kits (Mindray and Diasorin). Results 383 patients were included in our study. Among them, there were 71 subjects with eGFR > 90 (group one), 79 with eGFR 60–89 (group two), 108 with eGFR 30–59 (group three), 51 with eGFR 15–29 (group four), and 74 with eGFR < 15 (group five) ml/min per 1.73m2, respectively. In all subjects, PAC measured by CLIA [68.2(37.1-122.1) pg/ml for Mindray, 109.0(68.1–170.0) pg/ml for Diasorin] were significantly increased compared with those measured by LC-MS/MS [47.2(22.9–88.7) pg/ml]. The PAC measured by CLIA was positively correlated with that by LC-MS/MS, but the correlation coefficient diminished gradually with eGFR decline. Between LC-MS/MS and Diasorin CLIA kit, the difference of PAC increased with declined eGFR in groups one to five (76.8%, 69.2%, 113.2%, 152.2% and 476.2% for groups one to five, respectively). However, the difference increased only in group five in Mindray CLIA kit (46.4%, 48.1%, 45.7%, 45.0% and 74.9% for group one to five, respectively). Conclusion In patients with declined renal function, PAC measured by CLIA might be overestimated. Caution is needed in the interpretation of PAC in patients with severe renal impairment. When accurate measurements are required, LC-MS/MS should be considered.

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“…Solvent extraction significantly improves the correlation between methods suggesting a water-soluble metabolite may be cross-reacting in the direct immunoassay; this has also been previously demonstrated using extraction immunoassay ( 15 ). Aldosterone-18-glucuronide ( 17 ), the principal metabolite of aldosterone, is a likely candidate. Increases in this metabolite are unlikely to be a direct effect of COVID-19 infection but may reflect secondary organ dysfunction due to systemic illness.…”

Section: Discussionmentioning

confidence: 99%

“…Mass spectrometric methods for aldosterone are now increasingly available in clinical laboratories and do not suffer this interference. Whilst the clinical effectiveness of non-extraction immunoassays in the diagnosis of primary hyperaldosteronism is still contested ( 17 ), mass spectrometric methods are metrologically superior and are more likely to represent the biologically active aldosterone fraction.…”

Section: Introductionmentioning

confidence: 99%

Unquantifiably low aldosterone concentrations are prevalent in hospitalised COVID-19 patients but may not be revealed by chemiluminescent immunoassay

Wiegand

Halsall

Cowan

et al. 2022

Endocrine Connections

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Objective: Previous studies have reported conflicting findings regarding aldosterone levels in patients hospitalised with COVID-19. We therefore used the gold-standard technique of liquid chromatography tandem mass-spectrometry (LCMSMS) to address this uncertainty. Design: All patients admitted to Addenbrooke’s Hospital Cambridge with COVID-19 between March 10, 2020 and May 13, 2021, and in whom a stored blood sample was available for analysis, were eligible for inclusion. Methods: Aldosterone was measured by LCMSMS and by immunoassay; cortisol and renin were determined by immunoassay. Results: Using LCMSMS, aldosterone was below the limit of detection (<70 pmol/L) in 74 (58.7%) patients. Importantly, this finding was discordant with results obtained using a commonly employed clinical immunoassay (Liaison Diasorin®), which over-estimated aldosterone compared to the LCMSMS assay (intercept 14.1 [95% CI -34.4 to 54.1] + slope 3.16 [95% CI 2.09 to 4.15] pmol/L). The magnitude of this discrepancy did not clearly correlate with markers of kidney or liver function. Solvent extraction prior to immunoassay improved the agreement between methods (intercept -14.9 [95% CI -31.9 to -4.3] and slope 1.0 [95% CI 0.89 to 1.02] pmol/L) suggesting the presence of a water-soluble metabolite causing interference in the direct immunoassay. We also replicated a previous finding that blood cortisol concentrations were often increased, with increased mortality in the group with serum cortisol levels >744 nmol/L (p=0.005). Conclusion: When measured by LCMSMS, aldosterone was found to be profoundly low in a significant proportion of patients with COVID-19 at the time of hospital admission. This has likely not been detected previously due to high levels of interference with immunoassays in patients with COVID-19, and this merits further prospective investigation.

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In defense of aldosterone measurement by immunoassay: a broader perspective

Cited by 5 publications

References 8 publications

Comparison of plasma aldosterone measured by chemiluminescence immunoassay and liquid chromatography-tandem mass spectrometry in screening test for primary aldosteronism

Comparison of plasma aldosterone measured by chemiluminescence immunoassay and liquid chromatography-tandem mass spectrometry in screening test for primary aldosteronism

Comparison of chemiluminescence immunoassay with LC-MS/MS in the determination of plasma aldosterone concentration in patients with declined renal function

Unquantifiably low aldosterone concentrations are prevalent in hospitalised COVID-19 patients but may not be revealed by chemiluminescent immunoassay

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