The importance of knowing the timing within the menstrual cycle in nonmenopausal hypertensive women in the diagnostic workup for primary aldosteronism

We read with interest the paper by Ahmed el al (1), which demonstrates the importance of knowing the timing within the menstrual cycle when a diagnostic test is done for primary aldosteronism in non-menopausal women, reporting greater percentages of positive fludrocortisone suppression tests in the luteal compared to the follicular phase. Interestingly, a positive fludrocortisone test in the luteal phase was less likely to predict subsequent positive adrenal vein sampling than in the follicular phase, suggesting a lesser diagnostic accuracy of the test in the luteal phase. In their paper, the Authors focused on a late step of the diagnostic workup for hyperaldosteronism, that generally consists of performing a confirmatory test (such as the fludrocortisone test) after an initial laboratory positive screening test by means of determination of plasma aldosterone and renin levels. As also mentioned by Ahmed et al, some years ago we provided evidence that the menstrual cycle may affect the diagnostic performance for primary aldosteronism even in the early laboratory screening phase in hypertensive female patients (2) in a way similar to that observed by Ahmed, i.e. a higher "positivity" for suspected hyperaldosteronism when the test was done in the same women in the luteal compared to the follicular phase. We also recently confirmed this finding in an extended series of patients (3) (Fig 1). This article is protected by copyright. All rights reserved