Validation of primary aldosteronism (PA) discrimination score for confirmatory tests of PA

2019 ◽  
Vol 18 (1) ◽  
pp. e998-e999
Author(s):  
H. Yamamoto ◽  
S. Hatakeyama ◽  
K. Okita ◽  
S. Konishi ◽  
T. Matsumoto ◽  
...  
Keyword(s):  
Primary Aldosteronism ◽  
Discrimination Score ◽  
Confirmatory Tests

scholarly journals MP03-06 PATIENT SELECTION FOR CONFIRMATORY TESTS OF PRIMARY ALDOSTERONISM (PA) USING THE PA DISCRIMINATION SCORE

2018 ◽  
Vol 199 (4S) ◽  
Author(s):  
Hayato Yamamoto ◽  
Shingo Hatakeyama ◽  
Atsushi Imai ◽  
Hirotake Kodama ◽  
Ayumu Kusaka ◽  
...  
Keyword(s):  
Patient Selection ◽  
Primary Aldosteronism ◽  
Discrimination Score ◽  
Confirmatory Tests ◽  
Selection For

Patient selection for confirmatory tests of primary aldosteronism (PA) using the PA discrimination score

2018 ◽  
Vol 17 (2) ◽  
pp. e31-e32
Author(s):  
H. Yamamoto ◽  
S. Hatakeyama ◽  
T. Matsumoto ◽  
O. Soma ◽  
A. Kusaka ◽  
...  
Keyword(s):  
Patient Selection ◽  
Primary Aldosteronism ◽  
Discrimination Score ◽  
Confirmatory Tests ◽  
Selection For

scholarly journals MP69-01 VALIDATION OF PRIMARY ALDOSTERONISM (PA) DISCRIMINATION SCORE FOR CONFIRMATORY TESTS OF PA

2019 ◽  
Vol 201 (Supplement 4) ◽  
Author(s):  
Hayato Yamamoto* ◽  
Shingo Hatakeyama ◽  
Teppei Matsumoto ◽  
Yuichiro Suzuki ◽  
Tohru Yoneyama ◽  
...  
Keyword(s):  
Primary Aldosteronism ◽  
Discrimination Score ◽  
Confirmatory Tests

Primary Aldosteronism: The Role of Confirmatory Tests

2012 ◽  
Vol 44 (03) ◽  
pp. 177-180 ◽  
Author(s):  
M. Salvà ◽  
M. Cicala ◽  
F. Mantero
Keyword(s):  
Primary Aldosteronism ◽  
Confirmatory Tests

Development of a prediction score to avoid confirmatory testing in patients with suspected primary aldosteronism

2020 ◽  
Author(s):  
Jacopo Burrello ◽  
Martina Amongero ◽  
Fabrizio Buffolo ◽  
Elisa Sconfienza ◽  
Vittorio Forestiero ◽  
...  
Keyword(s):  
Machine Learning ◽  
Primary Aldosteronism ◽  
External Validation ◽  
Plasma Renin ◽  
Organ Damage ◽  
Internal Validation ◽  
Confirmatory Testing ◽  
Diagnostic Models ◽  
Confirmatory Tests ◽  
Diagnostic Work

Abstract Context The diagnostic work-up of primary aldosteronism (PA) includes screening and confirmation steps. Case confirmation is time-consuming, expensive, and there is no consensus on tests and thresholds to be used. Diagnostic algorithms to avoid confirmatory testing may be useful for the management of patients with PA. Objective Development and validation of diagnostic models to confirm or exclude PA diagnosis in patients with a positive screening test. Design, Patients and Setting We evaluated 1,024 patients who underwent confirmatory testing for PA. The diagnostic models were developed in a training cohort (n=522), and then tested on an internal validation cohort (n=174) and on an independent external prospective cohort (n=328). Main outcome measure Different diagnostic models and a 16-point score were developed by machine learning and regression analysis to discriminate patients with a confirmed diagnosis of PA. Results Male sex, antihypertensive medication, plasma renin activity, aldosterone, potassium levels and presence of organ damage were associated with a confirmed diagnosis of PA. Machine learning based models displayed an accuracy of 72.9-83.9%. The Primary Aldosteronism Confirmatory Testing (PACT) score correctly classified 84.1% at training and 83.9% or 81.1% at internal and external validation, respectively. A flow chart employing the PACT score to select patients for confirmatory testing, correctly managed all patients, and resulted in a 22.8% reduction in the number of confirmatory tests. Conclusions The integration of diagnostic modelling algorithms in clinical practice may improve the management of patients with PA by circumventing unnecessary confirmatory testing.

scholarly journals Diagnostics of primary aldosteronism: is obligatory use of confirmatory tests justified?

2012 ◽  
Vol 13 (3) ◽  
pp. 367-371 ◽  
Author(s):  
Janusz Myśliwiec ◽  
Łukasz żukowski ◽  
Anna Grodzka ◽  
Agata Piłaszewicz ◽  
Szymon Drągowski ◽  
...  
Keyword(s):  
Plasma Renin Activity ◽  
Primary Aldosteronism ◽  
Plasma Renin ◽  
Cost Effective ◽  
Plasma Aldosterone ◽  
Renin Activity ◽  
Plasma Aldosterone Concentration ◽  
Number Of Patients ◽  
Confirmatory Tests ◽  
Medical University

Introduction: Assessment of the renin-angiotensin-aldosterone system has been recently granted a much greater role in the evaluation of patients with arterial hypertension. There is no single test efficient in selection of patients for second-step etiological investigation. Methods: Altogether, 198 consecutive patients − 119 women (60%) and 79 men (40%) – hospitalized in years 2009–2011 at the Clinical Department of Endocrinology Medical University of Bialystok were diagnosed with primary aldosteronism. In each patient, plasma renin activity and plasma aldosterone concentration (basic and after 2 l NaCl infusion) were evaluated. Results: The percentage of patients with plasma aldosterone concentration ≥15 ng/ml was 53 and the percentage of patients with plasma renin activity ≤0.1 ng/ml/h was 20. The percentage of patients screened for primary aldosteronism in which the aldosterone:renin ratio exceeded consecutive cut-offs of 20, 30, 40 and 50 were respectively 57, 45, 34 and 29. Among 15 patients in which plasma aldosterone concentration after infusion of 2 l of saline was ≥6.5 ng/dl (8.6%), 13 (6.6%) were diagnosed with primary aldosteronism. Conclusion: The obligatory use of tests confirming autonomy of aldosterone secretion in patients screened for primary aldosteronism seems cost-effective in limiting the number of patients for further diagnosis.

656 COMPARISON OF VARIOUS CONFIRMATORY TESTS FOR FINAL DIAGNOSIS OF PRIMARY ALDOSTERONISM

2012 ◽  
Vol 30 ◽  
pp. e191
Author(s):  
Yuichi Takashi ◽  
Masao Omura ◽  
Mayu Kyohara ◽  
Yoko Matsuzawa ◽  
Jun Saito ◽  
...  
Keyword(s):  
Primary Aldosteronism ◽  
Final Diagnosis ◽  
Confirmatory Tests

scholarly journals Significance of Discordant Results: between Confirmatory Tests in Diagnosis of Primary Aldosteronism

2021 ◽  
Vol 5 (Supplement_1) ◽  
pp. A95-A96
Author(s):  
Tazuru Fukumoto ◽  
Hironobu Umakoshi ◽  
Masatoshi Ogata ◽  
Maki Yokomoto-Umakoshi ◽  
Yayoi Matsuda ◽  
...  
Keyword(s):  
Positive Result ◽  
Primary Aldosteronism ◽  
Challenge Test ◽  
Cross Sectional Study ◽  
Confirmatory Test ◽  
Double Positive ◽  
Cross Sectional ◽  
Confirmatory Tests ◽  
Single Positive

Abstract Context: Current clinical guidelines recommend confirmation of positive result in at least one confirmatory test in the diagnosis of primary aldosteronism (PA). Clinical implication of multiple confirmatory tests has not been established, especially when patients show discordant results. Objective: The aim of the present study was to explore the role of two confirmatory tests in subtype diagnosis of PA. Design: Retrospective cross-sectional study. Setting: The study was conducted at two referral centers. Participants and Method: We identified 360 hypertensive patients who underwent both captopril challenge test (CCT) and saline infusion test (SIT) and exhibited at least one positive result. Among them, we studied 193 patients with PA whose data were available for subtype diagnosis based on adrenal vein sampling (AVS). Main Outcome Measure: The prevalence of bilateral subtype on AVS according to the results of the confirmatory tests. Results: Of patients studied, 127 were positive for both CCT and SIT (double-positive), while 66 were positive for either CCT or SIT (single-positive) (n = 34 and n = 32, respectively). Altogether, 135 were diagnosed with bilateral subtype on AVS. The single-positive patients had milder clinical features of PA than the double-positive patients. The prevalence of bilateral subtype on AVS was significantly higher in the single-positive patients than in the double-positive patients. (63/66 [95.5%] vs. 72/127 [56.7%], P < 0.01). Several clinical parameters were different between CCT single-positive and SIT single-positive patients. Conclusion: Patients with discordant results between CCT and SIT have a high probability of bilateral subtype of PA on AVS.

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

2020 ◽  
Vol 105 (7) ◽  
pp. e2449-e2456 ◽  
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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