scholarly journals Plasma Aldosterone After Seated Saline Infusion Test Outperforms Captopril Test at Predicting Clinical Outcomes After Adrenalectomy for Primary Aldosteronism

2019 ◽  
Vol 32 (11) ◽  
pp. 1066-1074
Author(s):  
Che-Hsiung Wu ◽  
Vincent Wu ◽  
Ya-Wen Yang ◽  
Yen-Hung Lin ◽  
Shao-Yu Yang ◽  
...  
Keyword(s):  
Clinical Outcome ◽  
Primary Aldosteronism ◽  
Clinical Success ◽  
Final Analysis ◽  
Plasma Aldosterone ◽  
Saline Infusion ◽  
Infusion Test ◽  
Confirmatory Tests ◽  
Favorable Clinical Outcome ◽  
Captopril Test

Abstract OBJECTIVE The saline infusion test (SIT) and the captopril test (CT) are widely used as confirmatory tests for primary aldosteronism (PA). We hypothesized that post-SIT and post-CT plasma aldosterone concentrations (PAC) indicate the severity of aldosterone-producing adenoma (APA) and might predict clinical outcome. METHODS We recruited 216 patients with APA in the Taiwan Primary Aldosteronism Investigation (TAIPAI) registry who received both seated SIT and CT as confirmatory tests. The data of 143 patients who underwent adrenalectomy with complete follow-up after diagnosis were included in the final analysis. We determined the proportion of patients achieving clinical success in accordance with the Primary Aldosteronism Surgical Outcome consensus. Logistic regression analysis was conducted to identify preoperative factors associated with cure of hypertension. RESULTS Complete clinical success was achieved in 48 (33.6%) patients and partial clinical success in 59 (41.2%) patients; absent clinical success was seen in 36 (25.2%) of 143 patients. Post-SIT PAC but not post-CT PAC was independently associated with clinical outcome. Higher levels of post-SIT PAC had a higher likelihood of clinical benefit (complete plus partial clinical success; odds ratio = 1.04 per ng/dl increase, 95% confidence interval = 1.01, 1.06; P = 0.004). Patients with post-SIT PAC > 25 ng/dl were more likely to have a favorable clinical outcome after adrenalectomy. This cutoff value translated into a positive predictive value of 86.0%. CONCLUSIONS We suggest that post-SIT PAC is a better predictor than post-CT PAC for clinical success in PA post adrenalectomy.

scholarly journals The saline infusion test for primary aldosteronism: implications of immunoassay inaccuracy

2021 ◽  
Author(s):  
Graeme Eisenhofer ◽  
Max Kurlbaum ◽  
Mirko Peitzsch ◽  
Georgiana Constantinescu ◽  
Hanna Remde ◽  
...  
Keyword(s):  
Mass Spectrometry ◽  
Primary Aldosteronism ◽  
Tertiary Care ◽  
Plasma Aldosterone ◽  
Saline Infusion ◽  
Simple Solution ◽  
Infusion Test ◽  
Aldosterone Production ◽  
Tertiary Care Centers ◽  
Positive Results

Abstract Context Diagnosis of primary aldosteronism (PA) for many patients depends on positive results for the saline infusion test (SIT). Plasma aldosterone is often measured by immunoassays, which can return inaccurate results. Objective Establish whether differences in aldosterone measurements by immunoassay versus mass spectrometry (MS) might impact confirmatory testing for PA. Methods This study, involving 240 patients tested using the SIT at five tertiary-care centers, assessed discordance between immunoassay and MS-based measurements of plasma aldosterone. Results Plasma aldosterone measured by Liaison and iSYS immunoassays were respectively 86% and 58% higher than by MS. With an immunoassay-based SIT cut-off for aldosterone of 170 pmol/L, 78 and 162 patients had respective negative and positive results. All former patients had MS-based measurements of aldosterone <117 pmol/L, below MS-based cutoffs of 162 pmol/L. Among the 162 patients with pathogenic SIT results, MS returned non-pathologic results in 62, including 32 under 117 pmol/L. Repeat measurements by an independent MS method confirmed non-pathogenic results in 53 patients with discordant results. Patients with discordant results showed a higher (P<0.0001) prevalence of non-lateralized than lateralized adrenal aldosterone production than patients with concordant results (83%vs28%). Among patients with non-lateralized aldosterone production, 66% had discordant results. Discordance was more prevalent for the Liaison than iSYS immunoassay (32%vs16% P=0.0065) and was eliminated by plasma purification to remove interferents. Conclusions These findings raise concerns about the validity of immunoassay-based diagnosis of PA in over 60% of patients with presumed bilateral disease. We provide a simple solution to minimize immunoassay inaccuracy-associated misdiagnosis of PA.

Aldosterone level after saline infusion test could predict clinical outcome in primary aldosteronism after adrenalectomy

Surgery ◽  
2019 ◽  
Vol 166 (3) ◽  
pp. 362-368 ◽  
Author(s):  
Chieh-Kai Chan ◽  
Jung-Hee Kim ◽  
Eric Chueh ◽  
Chin-Chen Chang ◽  
Yu-Feng Lin ◽  
...  
Keyword(s):  
Clinical Outcome ◽  
Primary Aldosteronism ◽  
Saline Infusion ◽  
Infusion Test ◽  
Aldosterone Level

scholarly journals Evaluation of various confirmatory tests for the diagnosis of aldosterone-producing adenoma

2020 ◽  
Vol 21 (2) ◽  
pp. 147032032091961
Author(s):  
Satoshi Kidoguchi ◽  
Naoki Sugano ◽  
Ruri Kawauchi ◽  
Daisuke Nakashima ◽  
Naomi Hayashi-Ishikawa ◽  
...  
Keyword(s):  
Adrenocorticotropic Hormone ◽  
Challenge Test ◽  
Plasma Aldosterone ◽  
Stimulation Test ◽  
Saline Infusion ◽  
Infusion Test ◽  
Venous Sampling ◽  
Plasma Aldosterone Concentration ◽  
Hormone Stimulation ◽  
Confirmatory Tests

Introduction: Adrenal venous sampling is useful for discriminating unilateral and bilateral hypersecretion in patients with primary aldosteronism, but it is relatively invasive. To determine the site of hypersecretion more non-invasively, we evaluated predictors of unilateral hypersecretion. Materials and methods: We evaluated the baseline characteristics and the results of confirmatory tests of 123 patients with primary aldosteronism who underwent adrenal venous sampling. Results: Unilateral hypersecretion was identified in 22.0%. The plasma aldosterone concentration and aldosterone–renin ratio were significantly higher and serum potassium concentration and plasma renin activity were significantly lower in patients with unilateral hypersecretion. Plasma aldosterone concentrations after captopril challenge test, saline infusion test and rapid adrenocorticotropic hormone stimulation test were significantly higher among patients with unilateral hypersecretion. The plasma aldosterone concentration reduction ratio in saline infusion test and plasma aldosterone concentration elevation ratio during rapid adrenocorticotropic hormone stimulation test were significantly higher in patients with unilateral hypersecretion. However, areas under the curve for these parameters were not superior to the values after confirmatory tests. Conclusions: The plasma aldosterone concentration values after captopril challenge test, saline infusion test and rapid adrenocorticotropic hormone stimulation test were useful for identifying patients with unilateral hypersecretion. However, value changes or ratios during confirmatory tests are less useful for this aim.

scholarly journals Confirmatory testing in normokalaemic primary aldosteronism: the value of the saline infusion test and urinary aldosterone metabolites

2006 ◽  
Vol 154 (6) ◽  
pp. 865-873 ◽  
Author(s):  
Caroline Schirpenbach ◽  
Lysann Seiler ◽  
Christiane Maser-Gluth ◽  
Frank Rüdiger ◽  
Christian Nickel ◽  
...  
Keyword(s):  
Essential Hypertension ◽  
Primary Aldosteronism ◽  
Isotonic Saline ◽  
Secondary Hypertension ◽  
Saline Infusion ◽  
Infusion Test ◽  
Confirmatory Testing ◽  
Before And After ◽  
Confirmatory Tests

Objective: Primary aldosteronism has recently been recognized as the most frequent cause of secondary hypertension. Since most patients are normokalaemic, differentiation to essential hypertension is challenging. As differentiation by baseline aldosterone/renin ratio may be insufficient, diagnosis should be confirmed by additional tests. However, as most confirmatory tests have been evaluated in hypokalaemic primary aldosteronism only, we reassessed the value of the saline infusion test and 24 h urinary aldosterone metabolites as confirmatory tests for both normo- and hypokalaemic primary aldosteronism under current antihypertensive medication. Patients and methods: 25 patients with primary aldosteronism (11 hypokalaemic, 14 normokalaemic), 29 patients with essential hypertension and 47 normotensive subjects were studied. The hypertensives received their usual medication with the exception of spironolactone. All subjects underwent a standard saline infusion test (determination of plasma aldosterone before and after 2.0 liters of isotonic saline for 4 hours i.v.) and collected a 24 h urine sample for examination of urinary tetrahydroaldosterone and aldosterone-18-glucuronide. Results: In hypokalaemic primary aldosteronism the saline infusion test showed a reasonable sensitivity (91%) and specificity (90%). However, the test failed to differentiate sufficiently between essential hypertension and normokalaemic primary aldosteronism (sensitivity 57%, specificity 90%). Similarly, urinary tetrahydroaldosterone had higher sensitivity in hypokalaemic than in normokalaemic primary aldosteronism (sensitivity 64% vs 36%, specificity 100%), whereas for aldosterone-18-glucuronide, no differences in hypo- and normokalaemic primary aldosteronism were found (sensitivity 45% and 43%, specificity 100%). Conclusions: These data show that the saline infusion test as an established test in classical hypokalaemic primary aldosteronism is not a reliable test in the normokalaemic variant of the disease. Due to its low accuracy, determination of urinary aldosterone metabolites did not prove useful in confirming either normo- or hypokalaemic patients. We conclude from our data that these tests should not be used as confirmatory testing in the normokalaemic variant of primary aldosteronism.

Post saline infusion test aldosterone levels indicate severity and outcome in primary aldosteronism

2014 ◽  
Vol 122 (03) ◽  
Author(s):  
M Weigel ◽  
A Riester ◽  
G Hanslik ◽  
K Lang ◽  
S Endres ◽  
...  
Keyword(s):  
Primary Aldosteronism ◽  
Saline Infusion ◽  
Infusion Test

scholarly journals Saline Infusion Test highly associated with the incidence of cardio- and cerebrovascular events in primary aldosteronism

2017 ◽  
Vol 64 (5) ◽  
pp. 507-513 ◽  
Author(s):  
Reiko Hayashi ◽  
Daisuke Tamada ◽  
Masahiko Murata ◽  
Kosuke Mukai ◽  
Tetsuhiro Kitamura ◽  
...  
Keyword(s):  
Primary Aldosteronism ◽  
Saline Infusion ◽  
Infusion Test ◽  
Cerebrovascular Events

Arterial Stiffness Is Associated with Clinical Outcome and Cardiorenal Injury in Lateralized Primary Aldosteronism

2020 ◽  
Vol 105 (11) ◽  
Author(s):  
Chieh-Kai Chan ◽  
Wei-Shiung Yang ◽  
Yen-Hung Lin ◽  
Kuo-How Huang ◽  
Ching-Chu Lu ◽  
...  
Keyword(s):  
Arterial Stiffness ◽  
Clinical Outcome ◽  
Left Ventricular Mass ◽  
Primary Aldosteronism ◽  
Clinical Success ◽  
Multivariate Logistic Regression Analysis ◽  
Left Ventricular ◽  
Secondary Outcome ◽  
Ventricular Mass

Abstract Context The association between arterial stiffness and clinical outcome in lateralized primary aldosteronism (PA) patients after adrenalectomy has not been clearly identified. Objective We hypothesized that arterial stiffness estimated by brachial-ankle pulse wave velocity (baPWV) before adrenalectomy was associated with the clinical outcomes and cardiorenal injury in lateralized PA patients after adrenalectomy. Design and Patients We designed a retrospective observational cohort study. We collected lateralized PA patients who had undergone adrenalectomy between 2013 and 2016 from the Taiwan Primary Aldosteronism Investigation database. The primary outcome was achieving complete clinical success at 1 year after adrenalectomy. The secondary outcome was estimated glomerular filtration rate declining over 20% and improved left ventricular mass index. Results We enrolled 221 patients with lateralized PA (50.7% men; mean age, 51.9 years), of whom 101 patients (45.7%) achieved complete clinical success at the 1-year follow-up assessment after adrenalectomy. Lower baPWV before adrenalectomy (odds ratio = 0.998; 95% confidence interval, 0.996-0.999; P = 0.003) correlated with higher likelihood of complete clinical success by multivariate logistic regression analysis. Multifactorial adjusted generalized additive model demonstrated that preoperative baPWV<1600 cm/sec was significantly associated with complete cure of hypertension. In addition, higher preoperative baPWV was associated with renal function decline and less left ventricular mass regression after adrenalectomy in lateralized PA patients during the follow-up period. Conclusions Our study demonstrated that the preoperative severe arterial stiffness was associated with absent complete clinical success in lateralized PA patients after adrenalectomy, and this effect may contribute to cardiorenal injury, which at least partially explains kidney function deterioration and lessened regression of heart mass.

A combination of captopril challenge test after saline infusion test improves diagnostic accuracy for primary aldosteronism

2019 ◽  
Vol 92 (2) ◽  
pp. 131-137 ◽  
Author(s):  
Chuan Lin ◽  
Jun Yang ◽  
Peter J. Fuller ◽  
Huan Jing ◽  
Ying Song ◽  
...  
Keyword(s):  
Diagnostic Accuracy ◽  
Primary Aldosteronism ◽  
Challenge Test ◽  
Saline Infusion ◽  
Infusion Test

scholarly journals Post-saline infusion test aldosterone levels indicate severity and outcome in primary aldosteronism

2015 ◽  
Vol 172 (4) ◽  
pp. 443-450 ◽  
Author(s):  
Marianne Weigel ◽  
Anna Riester ◽  
Gregor Hanslik ◽  
Katharina Lang ◽  
Holger S Willenberg ◽  
...  
Keyword(s):  
Primary Aldosteronism ◽  
Rapid Development ◽  
Specific Treatment ◽  
Saline Infusion ◽  
Confirmatory Test ◽  
Infusion Test ◽  
Protein Excretion ◽  
Unilateral Disease ◽  
Group 2

ObjectiveThe saline infusion test (SIT) is widely used as a confirmatory test for primary aldosteronism (PA). SIT results are judged as follows: post-test aldosterone levels <50 ng/l exclude PA, whereas levels >50 ng/l confirm PA. We hypothesized that post-SIT aldosterone concentrations indicate the severity of PA and might predict outcome.DesignThe study includes 256 PA patients of the German Conn's Registry who prospectively underwent SIT. The data of 126 patients with complete follow-up of 1.2±0.3 years after diagnosis were analyzed. The patients were divided into two groups with post-SIT aldosterone levels of 50–100 ng/l (group 1; n=38) and of >100 ng/l (group 2; n=88).ResultsPatients in group 2 had a significantly shorter duration of hypertension (7.5 vs 11.7 years (median), P=0.014), higher systolic blood pressure (BP; 151±16 vs 143±17 mmHg, P=0.036), lower serum potassium (3.3±0.6 vs 3.5±0.4 mmol/l, P=0.006), higher 24-h urine protein excretion (7.4 vs 5.4 mg/dl (median), P=0.012), and were more often female (P=0.038). They showed more often unilateral disease (P<0.005) with larger tumors (14±10 vs 7±10 mm, P=0.021), underwent more often adrenalectomy (75% vs 37%, P<0.005), required a lower number of antihypertensive drugs after adrenalectomy (1.2±1.2 vs 2.5±1.4, P=0.001), had a faster normalization of urinary protein excretion (with medical treatment P=0.049; with Adx P<0.005) at follow-up, and more frequently underlying well-characterized mutation (P=0.047).ConclusionsPA patients with post-SIT aldosterone levels of >100 ng/l have a more rapid development of PA caused more frequently by unilateral disease with larger aldosterone-producing adenomas. However, this group of patients may have a significantly better outcome following specific treatment.

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.

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