Aldosterone
Hormones marker
Aldosterone
Mineralocorticoid hormone produced by the adrenal zona glomerulosa. Regulates sodium retention, potassium excretion, and blood pressure as the final effector of the renin-angiotensin-aldosterone system (RAAS).
PED Notes
Highly relevant to enhanced athletes who already battle hypertension and fluid retention. Primary aldosteronism is a common, under-diagnosed cause of resistant high blood pressure and should be considered in any AAS user with hard-to-control hypertension, especially alongside low or low-normal potassium. High dietary sodium and the mineralocorticoid-like sodium-retaining activity of some AAS drive fluid retention and blood pressure on cycle. Licorice (glycyrrhizin) mimics aldosterone and can produce a similar picture with suppressed aldosterone. Always interpret aldosterone with renin and the aldosterone-renin ratio (ARR), and note that results are strongly posture and time dependent.
When high
When HIGH (with suppressed renin):
- High aldosterone with a suppressed renin and a raised aldosterone-renin ratio (ARR) is the classic screen for primary aldosteronism (Conn's syndrome), a common and treatable cause of resistant hypertension
- In enhanced athletes this matters: untreated primary aldosteronism drives high blood pressure, low potassium, and long-term cardiovascular and kidney damage on top of AAS cardiovascular risk
- Confirm with formal testing (saline suppression or other confirmatory test) and adrenal imaging under endocrinology before treatment; do not self-diagnose from a single draw
When HIGH (with high renin -- secondary):
- Aldosterone rising in step with renin (secondary hyperaldosteronism) points to RAAS activation: dehydration, diuretic use, heart failure, renal artery narrowing, or aggressive sodium restriction
- Address the underlying driver rather than the aldosterone itself
Practical notes:
- Posture matters: upright/seated samples run higher than supine. Standardise collection (commonly seated for 15-30 minutes) and record posture and time of day
- Correct low potassium before interpreting, as hypokalaemia can falsely lower aldosterone
- Mineralocorticoid receptor antagonists (spironolactone, eplerenone) are the medical treatment for confirmed primary aldosteronism and are physician-managed; spironolactone is also anti-androgenic, which athletes should be aware of
When low
When LOW:
- Low aldosterone with high renin can indicate primary adrenal insufficiency (Addison's disease) or hypoaldosteronism; pair with potassium, sodium, cortisol, and ACTH
- Low aldosterone with low renin can follow licorice (glycyrrhizin) ingestion, which mimics mineralocorticoid activity, or certain rare syndromes
- Drugs commonly lower aldosterone: ACE inhibitors, angiotensin receptor blockers, beta-blockers, and NSAIDs
- Persistent unexplained low aldosterone with electrolyte disturbance warrants medical review
Clinical context:
- Aldosterone is best interpreted together with renin and the aldosterone-renin ratio; an isolated value is hard to act on
- Screening conditions matter: avoid excessive sodium restriction, correct potassium, standardise posture and timing, and where possible review the washout of interfering medications with a clinician before testing
- Reference ranges are posture and assay specific; the seated adult range is roughly 100-950 pmol/L, with supine values lower
History Chart
Reading History
Frequently Asked Questions
Reference Ranges
Standard Range
VitalMetrics Range