Identification of novel transcriptomic markers of PA

Whilst dichotomous thresholds are currently used to diagnose primary aldosteronism (PA), emerging data support the concept of a continuum of aldosterone excess. A robust cellular marker of aldosterone excess that correlates strongly with clinical outcomes following mineralocorticoid receptor (MR) antagonist treatment or adrenalectomy will complement the aldosterone-renin ratio (ARR) and confirmatory tests in the diagnostic algorithm for PA. As peripheral blood monocytes highly express the MR, they represent an accessible MR-responsive tissue to study aldosterone-induced changes in gene transcription. A number of genes identified by previous students will be characterised in vitro using RT-PCR and cell culture to confirm a change in their expression in response to MR activation or antagonism. These may then be validated in larger patient cohorts as robust biomarkers of aldosterone excess and inappropriate MR activation.