Primary Aldosteronism Screening and Diagnosis at St. Paul's Hospital

St. Paul’s Hospital Laboratory has been a world leader in the development of accurate diagnostic assays for the diagnosis of primary aldosteronism and a number of other related conditions affecting the renin angiotensin aldosterone system. St. Paul’s Hospital laboratory is the only site in Canada offering aldosterone, and plasma renin activity testing by tandem mass spectrometry and acts as a reference lab for numerous research studies, other labs and even diagnostic companies for aldosterone analysis.

All confirmatory testing for primary aldosteronism and all adrenal venous sampling analysis for the province of British Columbia is performed at St. Paul’s Hospital. Three experienced laboratory physicians, Dr. Andre Mattman, Dr. Janet Simons and Dr. Daniel Holmes review all primary aldosteronism screens, confirmatory tests and adrenal venous sampling results, rendering interpretations in collaboration with the caring physician. St. Paul’s performs about 2000 screens for primary aldosteronism, 200 confirmatory tests and 75 adrenal venous sampling analyses per year. The clinical team has numerous publications on the topic of the laboratory investigation of primary aldosteronism.

Additionally, St. Paul’s Hospital is one of the two locations of the British Columbia Hypertension Clinic (www.rhtn.ca) which specializes in the clinical investigation and management of complex hypertension cases including primary aldosteronism and pheochromocytoma. Experienced internists Dr. Jane McKay, Dr. Nadia Khan, Dr. Debbie Rosenbaum, Dr. Laura Kuyper and Dr. Cori Gabana actively see patients for primary aldosteronism workup on short notice. For referrals to these clinicians, please see the clinic referral page (http://rhtn.ca/contact-us).

Selected Publications:

Van Der Gugten JG, Dubland J, Liu HF, Wang A, Joseph C, Holmes DT. Determination of serum aldosterone by liquid chromatography and tandem mass spectrometry: a liquid–liquid extraction method for the ABSCIEX API-5000 mass spectrometry system. Journal of clinical pathology. 2012 May 1;65(5):457-62.

Van Der Gugten JG, Crawford M, Grant RP, Holmes DT. Supported liquid extraction offers improved sample preparation for aldosterone analysis by liquid chromatography tandem mass spectrometry. Journal of clinical pathology. 2012 Nov 1;65(11):1045-8.

Van Der Gugten JG, Holmes DT. Quantitation of aldosterone in serum or plasma using liquid chromatography-tandem mass spectrometry (LC-MS/MS). In Clinical Applications of Mass Spectrometry in Biomolecular Analysis 2016 (pp. 37-46). Humana Press, New York, NY.

Camenzind AG, van der Gugten JG, Popp R, Holmes DT, Borchers CH. Development and evaluation of an immuno-MALDI (iMALDI) assay for angiotensin I and the diagnosis of secondary hypertension. Clinical proteomics. 2013 Dec;10(1):20.

Van Der Gugten JG, Holmes DT. Quantitation of Plasma Renin Activity in Plasma Using Liquid Chromatography–Tandem Mass Spectrometry (LC-MS/MS). In Clinical Applications of Mass Spectrometry in Biomolecular Analysis 2016 (pp. 243-253). Humana Press, New York, NY.

Kline GA, Darras P, Leung AA, So B, Chin A, Holmes DT. Surprisingly low aldosterone levels in peripheral veins following intravenous sedation during adrenal vein sampling: implications for the concept of non-suppressibility in primary aldosteronism. Journal of hypertension. 2019 Mar 1;37(3):596-602.

Rehan M, Raizman JE, Cavalier E, Don-Wauchope AC, Holmes DT. Laboratory challenges in primary aldosteronism screening and diagnosis. Clinical biochemistry. 2015 Apr 1;48(6):377-87.

Kline G, Holmes DT. Adrenal venous sampling for primary aldosteronism: laboratory medicine best practice. Journal of clinical pathology. 2017 Nov 1;70(11):911-6.