Diagnostic value of the post-captopril test in primary aldosteronism

Abstract Context Urinary aldosterone levels (Uald) are widely measured in the oral sodium-loading test to confirm primary aldosteronism (PA), but reliable studies on their diagnostic value are limited. This may be due to the difficulty in collecting urine with reliable accuracy, keeping oral sodium intake constant between patients. Therefore, we focused on 24-hour Uald after intravenous saline infusion in a hospitalized setting, which provides a reliable sodium load in consistent amounts. Objective Comparing plasma aldosterone concentrations (PAC) and Uald after saline infusion in the sitting position, to evaluate the accuracy in determining PA subtypes and the correlation of both measurements. Design and Setting This was a retrospective cross-sectional study in a single referral center. Patients Of 53 patients without renal dysfunction who were diagnosed with PA and underwent adrenal venous sampling, 16 and 37 were diagnosed with unilateral and bilateral PA, respectively. Main Outcome Measures Uald collected for 24 hours and PAC after saline infusion. Results The area under the receiver operating characteristic curve for diagnosing unilateral PA was not significantly different between Uald and PAC after saline infusion (0.921 and 0.958, respectively; P = 0.370). The predicted optimal cutoff value of Uald was 16.5 μg/day (sensitivity, 87.5%; specificity, 100%), and that of PAC after saline infusion was 19.3 ng/dL (sensitivity, 87.5%; specificity, 97.3%). In studied patients with PA, Uald was positively correlated with PAC after saline infusion (r = 0.617; P < 0.001). Conclusions We reassessed Uald in PA patients under sufficient sodium loading and demonstrated the correlation between Uald and PAC after saline infusion.

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The captopril test for the screening of primary aldosteronism

American Journal of Hypertension ◽

10.1016/s0895-7061(01)01994-x ◽

2001 ◽

Vol 14 (11) ◽

pp. A251-A252

Author(s):

G Regolisti

Keyword(s):

Primary Aldosteronism ◽

Captopril Test

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Development and Validation of Criteria for Sparing Confirmatory Tests in Diagnosing Primary Aldosteronism

The Journal of Clinical Endocrinology & Metabolism ◽

10.1210/clinem/dgaa282 ◽

2020 ◽

Vol 105 (7) ◽

pp. e2449-e2456 ◽

Cited By ~ 1

Author(s):

Kanran Wang ◽

Jinbo Hu ◽

Jun Yang ◽

Ying Song ◽

Peter J Fuller ◽

...

Keyword(s):

Primary Aldosteronism ◽

Challenge Test ◽

Plasma Renin ◽

Diagnostic Value ◽

Endocrine Society ◽

Plasma Aldosterone Concentration ◽

Hypertensive Patients ◽

Confirmatory Tests ◽

Chinese Cohort ◽

Development And Validation

Abstract Context The Endocrine Society Guidelines for the diagnosis of primary aldosteronism (PA) suggest that confirmatory tests (CFT) are not required when the following criteria are met: plasma aldosterone concentration (PAC) is >20 ng/dL, plasma renin is below detection levels, and hypokalemia is present. The evidence for the applicability of the guideline criteria is limited. Objective To develop and validate optimized criteria for sparing CFT in the diagnosis of PA. Design and Setting The optimized criteria were developed in a Chinese cohort using the captopril challenge test, verified by saline infusion test (SIT) and fludrocortisone suppression test (FST), and validated in an Australian cohort. Participants Hypertensive patients who completed PA screening and CFT. Main Outcome Measure Diagnostic value of the optimized criteria. Results In the development cohort (518 PA and 266 non-PA), hypokalemia, PAC, and plasma renin concentration (PRC) were selected as diagnostic indicators by multivariate logistic analyses. The combination of PAC >20 ng/dL plus PRC <2.5 μIU/mL plus hypokalemia had much higher sensitivity than the guideline criteria (0.36 vs 0.11). The optimized criteria remained superior when the SIT or FST were used as CFT. Non-PA patients were not misdiagnosed by either criteria, but the percentage of patients in whom CFT could be spared was higher with the optimized criteria. In the validation cohort (125 PA and 81 non-PA), the sensitivity of the optimized criteria was also significantly higher (0.12 vs 0.02). Conclusions Hypertensive patients with PAC >20 ng/dL, PRC <2.5 μIU/mL, plus hypokalemia can be confidently diagnosed with PA without confirmatory tests.

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The Usefulness of the Captopril Test as a Simultaneous Screening for Primary Aldosteronism and Renovascular Hypertension

American Journal of Hypertension ◽

10.1093/ajh/6.11.899 ◽

1993 ◽

Vol 6 (11_Pt_1) ◽

pp. 899-906 ◽

Cited By ~ 12

Author(s):

Taisuke Iwaoka ◽

Teruhisa Umeda ◽

Shojiro Naomi ◽

Junnosuke Inoue ◽

Masato Sasaki ◽

...

Keyword(s):

Renovascular Hypertension ◽

Primary Aldosteronism ◽

Captopril Test

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Minor Change of Plasma Renin Activity during the Saline Infusion Test Provide an Auxiliary Diagnostic Value for Primary Aldosteronism

International Journal of Endocrinology ◽

10.1155/2021/5757305 ◽

2021 ◽

Vol 2021 ◽

pp. 1-9

Author(s):

Munire Adilijiang ◽

Qin Luo ◽

Menghui Wang ◽

Delian Zhang ◽

Xiaoguang Yao ◽

...

Keyword(s):

Plasma Renin Activity ◽

Primary Aldosteronism ◽

Plasma Renin ◽

Diagnostic Value ◽

Saline Infusion ◽

Renin Activity ◽

Infusion Test ◽

Study Objective ◽

Study Results ◽

Significant Difference

Context. Failure of plasma aldosterone suppression during the saline infusion test (SIT) confirms primary aldosteronism (PA); recommendations for diagnostic strategies are currently controversial in the case of an inconclusive test result with a post-SIT PAC 5–10 ng/dl, while the renin change during SIT is not focused by the previous study. Objective. To clarify whether it has some hidden diagnostic values for PA, especially in the case of an inconclusive SIT result, we investigated the difference in changes of plasma renin activity (PRA) during SIT between patients with PA and non-PA. Methods. We measured and compared the SIT parameters of 159 PA patients, 368 non-PA patients, and 43 inconclusive patients who were included in this study. Results. The PA group showed a minor change of PRA during the SIT (ΔPRA, defined as (pre-SIT PRA–post-SIT PRA)) compared with the non-PA group (0.17 ng/ml/h vs. 1.07 ng/ml/h, P < 0.001 ). According to ROC analysis, ΔPRA showed a greater AUC than post-SIT PRA (0.897 vs. 0.855, P < 0.001 ). The cutoff value was 0.5 ng/ml/h, with 90.3% sensitivity and 78.6% specificity. When combined with ARR post-SIT, it showed 81.6% sensitivity and 97.0% specificity for PA diagnosis. Further analysis of 43 patients with an inconclusive SIT result who completed AVS found that ΔPRA was smaller in the confirmed PA group compared with the unconfirmed PA group (0.19 ng/ml/h vs. 0.29 ng/ml/h, P < 0.05 ); there was no significant difference in PAC post-SIT between two groups. ΔPRA ≤ 0.21 ng/ml/h provides 71.4% sensitivity, 80.0% specificity, and 87.0% PPV for their PA diagnosis. Conclusions. PA patients show minor PRA change during SIT; the change of PRA during SIT provides an auxiliary diagnostic value for PA, especially in patients with an inconclusive SIT result.

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