Home
HelpTest Code SOFT: ACTHS ACTHS/Aldosterone Stimulation Test
Additional Codes
|
Ordering Mnemonic |
Mayo Test ID |
|
EPIC NAME: ACTHS/ALDOSTERONE STIMULATION TEST |
ALDS |
EPIC CODE: LAB711
Useful For
Investigating 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 Required
- Six total specimens should be submitted for this testing
- 3 Green tops for Cortisol testing performed at SFMC Lab (Base, 30 minute, 60 minute draws)
- 3 Red tops for Aldosterone ACTHS testing performed at Mayo (Base, 30 minute, 60 minute draws)
SPECIAL PROCESSING INSTRUCTIONS:
-The 3 red tops should be spun down. Then 1.2 mls of serum poured into 3 separate mailout tubes accourding to collection times (this information should be on the labels)
Test must be manually ordered in Mayo Access.
How to Manualy order in Mayo Access- See Procedure ACTHS / ALDOS STIM Test
Collection Container/Tube Preferred: Red top
Acceptable: Serum gel
Submission Container/Tube: Plastic vial
Specimen Volume: 1.2 mL
Patient Preparation: Spironolactone (Aldactone) should be discontinued for 4 to 6 weeks before testing. The plasma renin activity cannot be interpreted if the patient is being treated with spironolactone.
Collection Instructions:
1. See Renin-Aldosterone Studies for detailed instructions.
2. The recommended collection time is 8 a.m., after the patient is active for approximately 2 hours. Try to collect the specimen as close to that time as possible and no later than 10 a.m.
3. Centrifuge and aliquot serum into a plastic vial.
Specimen Minimum Volume
1.2 ml
Specimen Stability Information
|
Specimen Type |
Temperature |
Time |
Special Container |
|
Serum |
Refrigerated (preferred) |
28 days |
|
|
|
Frozen |
30 days |
|
|
|
Ambient |
4 days |
Performing Laboratory
Mayo Clinic Laboratories in Rochester
Reference Values
0-30 days: 17-154 ng/dL*
31 days-11 months: 6.5-86 ng/dL*
1-10 years:
≤40 ng/dL (supine)*
≤124 ng/dL (upright)*
≥11 years: ≤21 ng/dL (a.m. peripheral vein specimen)
Day(s) Performed
Monday through Friday
Method Name
Liquid Chromatography Tandem Mass Spectrometry (LC-MS/MS)
CPT Code Information
82088
LOINC Code Information
|
Test ID |
Test Order Name |
Order LOINC Value |
|
ALDS |
Aldosterone, S |
1763-2 |
|
Result ID |
Test Result Name |
Result LOINC Value |
|
8557 |
Aldosterone, S |
1763-2 |
Test Classification
This test was developed and its performance characteristics determined by Mayo Clinic in a manner consistent with CLIA requirements. It has not been cleared or approved by the US Food and Drug Administration.
Clinical Information
Aldosterone stimulates sodium transport across cell membranes, particularly in the distal renal tubule where sodium is exchanged for hydrogen and potassium. Secondarily, aldosterone is important in the maintenance of blood pressure and blood volume.
Aldosterone is the major mineralocorticoid and is produced by the adrenal cortex.
The renin-angiotensin system is the primary regulator of the synthesis and secretion of aldosterone. Likewise, increased concentrations of potassium in the plasma may directly stimulate adrenal production of the hormone. Under physiologic conditions, pituitary adrenocorticotropic hormone is not a major factor in regulating aldosterone secretion.
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 greater than or equal to 20 is only interpretable with an SA greater than or equal to 15 ng/dL and indicates probable primary aldosteronism.
Kidney 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) greater than 1.5.
Method Description
Aldosterone-d6 is added to serum and plasma samples as an internal standard. Aldosterone and aldosterone-d6 are extracted from the specimens using a Strata X cartridge. The eluate is dried down under nitrogen, reconstituted with 70/30 methanol/water containing estriol and analyzed by liquid chromatography tandem mass spectrometry using multiple reaction monitoring in the negative mode.(Fredline VF, Taylor PJ, Dodds HM, Johnson AG: A reference method for the analysis of aldosterone in blood by high-performance liquid chromatography-atmospheric pressure chemical ionization-tandem mass spectrometry. Anal Biochem. 1997 Oct 15;252(2):308-313)
Report Available
2 to 5 days
Specimen Retention Time
14 days