Recentstudieshaveshownthatprimaryaldosteronism(PA)isthemostcommoncauseofsecondaryhypertensionwithaprevalenceofapproximately5-10%amongallhypertensivepatientsandanevenhigherprevalenceamongselectedpatientswithadvancedstagesofhypertensionandresistanthypertension.(1)  ScreeningforPAamonghypertensivepatientsisimportantdue ​toitsassociationwithriskforcardiovasculardiseaseandrenaldamage,(1)andnon-invasivesalivaryaldosteronemeasurementshaverecentlybeenexploredasameanstofacilitatethisscreening.  MorningsalivaryaldosteronemeasurementsalonewerefoundtohavesomeABIlitytodiscriminatebetweenpatientswithPAandessentialhypertension,andthepresenceorabsenceofadiurnaldeclineshowedpromisefordistinguishingbetweenthetwoformsofthedisease(adenomasvs.bilateralhyperplasia).(2) 

Dysregulationofcirculatingaldosteronelevelshasalsobeenassociatedwithpsychiatricdisorders,andarecentstudyhassimilarlyreportedasignificantnegativeassociationbetweenmorningsalivaryaldosteronelevelsandtraitanxietyscores. Thosewiththehighanxietytraitmaybeassociated withaninabilitytorespondwithadequatecortisollevelsduringstress.(3)

Producedlargelyintheadrenal glands,aldosteroneisclassifiedasamineralocorticoidsteroidsinceitsclassicaleffectistoregulatethetransportofsodiumandwateracrosscellsofthekidneyinexchangeforpotassiumandhydrogenions,therebyregulatingbloodvolumeandpressure.(4,5)  

Additionally,rapidnon-genomicactionsandlocalproductionofaldosteronehavebeenidentifiedinothertissues,includingtheheart,vascularsystem,adrenalgland,andkidney.  Thesenon-genomicmechanismsarebeingstudiedinconnectionwitharangeofdiseasesincludingcardiovasculardisease,cirrhosis,kidneydisease,insulinresistance,anddiabetes.(6,7,8)

Nospecificbindingproteinforaldosteronehasbeenidentifiedinblood.(4)   Circulatingaldosteronenotboundtoserumproteinsenterssalivabypassivediffusion.(9)  Salivaryaldosteronelevelscorrespondapproximatelyto30%ofthosefoundinplasma,withgoodcorrelationfoundbetweenplasmaandnon-extractedsalivaryaldosterone.(10)  Salivaryaldosteronelevelsareunaffectedbysalivaryflowrateorhormone-bindingproteins.(11)  Bothsalivaryandplasmaaldosteroneincreasesignificantlywhilestanding,comparedtobeingseated;thiseffectissignificantlyhigherinfemalesthaninmales.  Adiurnalrhythmforsalivaryaldosteroneexistsforhealthyindividuals,withhighestlevelsinthemorning.(10)

1. Pilz,S.,Tomaschitz,A.,Stepan,V.,Obermayer-Pietsch,B.,Fahrleitner-Pammer,A.,Schweighofer,N.,Portugaller,H.R.,etal.(2009).GrazEndocrineCausesofHypertension(GECOH)study:Adiagnosticaccuracystudyofaldosteronetoactivereninratioinscreeningforprimaryaldosteronism.BMCEndocrDisord,9:11.
2. Manolopoulou,J.,Gerum,S.,Mulatero,P.,Rossignol,P.,Plouin,P.F.,Reincke,M.,&Bidlingmaier,M.(2010).Salivaryaldosteroneasadiagnosticaidinprimaryaldosteronism.HormMetabRes,42(6),400-5.
3. Jezova,D.&Hlavacova,N.(2008).Endocrinefactorsinstressandpsychiatricdisorders.AnnNYAcadSci,1148,495-503.
4. Williams,G.H.(2005).Aldosteronebiosynthesis,regulation,andclassicalmechanismofaction.HeartFailRev,10(1),7-13.
5. Meneton,P.,Loffing,J.,&Warnock,D.G.(2004).Sodiumandpotassiumhandlingbythealdosterone-sensitivedistalnephron:Thepivotalroleofthedistalandconnectingtubule.AmJPhysiolRenalPhysiol,287(4),F593-601.
6. Vogt,B.&Burnier,M.(2009).Aldosteroneandcardiovascularrisk.CurrHypertensRep,11(6),450-55.
7. Schrier,R.W.,Masoumi,A.,&Elhassan,E.(2010).Aldosterone:Roleinedematousdisorders,hypertension,chronicrenalfailure,andmetabolicsyndrome.ClinJAmSocNephrol,5(6),1132-40.
8. Whaley-Connell,A.,Johnson,M.S.,&Sowers,J.R.(2010).Aldosterone:Roleinthecardiometabolicsyndromeandresistanthypertension.ProgCardiovascDis,52(5),401-9.
9. Vining,R.F.,McGinley,R.A.,Symons,R.G.(1983).Hormonesinsaliva:Modeofentryandconsequentimplicationsforclinicalinterpretation.ClinChem,29(10),1752-56.
10. Manolopoulou,J.,Mulatero,P.,Maser-Gluth,C.,Rossignol,P.,Spyroglou,A.,Vakrilova,Y.,Petersenn,S.,etal.(2009).Salivaasamediumforaldosteronemeasurementinrepeatedsamplingstudies.Steroids,74(10-11),853-58.
11. Vining,R.F.,McGinley,R.A.(1987).Themeasurementofhormonesinsaliva:Possibilitiesandpitfalls.JSteroidBiochem,27(1-3),81-94.