Role of 17-Ketosteroids Test in Diagnosing Hypertension
The 17-ketosteroids (17-KS) test is not recommended or included in current hypertension guidelines for the routine evaluation of hypertension. Based on the most recent American College of Cardiology/American Heart Association (ACC/AHA) guidelines, this test is not part of the standard screening or diagnostic workup for hypertension or secondary causes of hypertension 1.
Current Recommended Diagnostic Tests for Hypertension
The ACC/AHA and International Society of Hypertension guidelines recommend the following tests for initial evaluation of hypertension:
- Basic laboratory tests: sodium, potassium, serum creatinine, estimated GFR, fasting glucose, lipid profile, urinalysis 1
- 12-lead ECG to detect atrial fibrillation, left ventricular hypertrophy, and ischemic heart disease 1
- Additional tests only when clinically indicated to assess hypertension-mediated organ damage or secondary causes 1
Evaluation for Secondary Causes of Hypertension
When secondary hypertension is suspected, specific diagnostic tests are recommended based on the suspected cause:
- For primary aldosteronism: aldosterone-renin ratio 1
- For pheochromocytoma: 24-hour urinary fractionated metanephrines or plasma metanephrines 1
- For Cushing's syndrome: overnight 1-mg dexamethasone suppression test, 24-hour urinary free cortisol 1
- For thyroid disorders: thyroid-stimulating hormone, free thyroxine 1
- For congenital adrenal hyperplasia: assessment of hypertension and hypokalemia with low or normal aldosterone and renin 1
17-Ketosteroids and Congenital Adrenal Hyperplasia
The 17-KS test is only mentioned in the context of congenital adrenal hyperplasia (CAH), which is a rare cause of secondary hypertension 1. For CAH, current guidelines recommend:
- Screening with assessment of hypertension and hypokalemia with low or normal aldosterone and renin 1
- Confirmatory tests include measuring elevated deoxycorticosterone (DOC), 11-deoxycortisol, and androgens (for 11-beta-hydroxylase deficiency) or decreased androgens and estrogen with elevated deoxycorticosterone and corticosterone (for 17-alpha-hydroxylase deficiency) 1
Historical Context of 17-Ketosteroids Testing
Historically, 17-ketosteroids testing had been used in the evaluation of adrenal disorders. In a 1966 study, elevated urinary 17-ketosteroids were noted in some cases of hypertension with increased aldosterone secretion 2. However, this test has been largely replaced by more specific and sensitive tests in modern practice.
Modern Approach to Adrenal Steroid Evaluation
Current research indicates that comprehensive adrenal steroid profiling may provide insights into metabolic alterations in patients with endocrine hypertension 3. However, these approaches focus on specific steroids rather than the older, less specific 17-KS test.
Practical Approach to Suspected Secondary Hypertension
For patients with suspected secondary hypertension, the recommended approach is:
- Identify clinical clues suggesting secondary hypertension (resistant hypertension, early onset, etc.) 1
- Perform targeted screening tests based on clinical suspicion 1
- For adrenal causes, use specific tests for the suspected condition rather than general 17-KS testing 1
Conclusion
The 17-ketosteroids test has no established role in the current diagnostic evaluation of hypertension according to contemporary guidelines. Modern practice relies on more specific and sensitive tests tailored to the suspected underlying cause of secondary hypertension 1.