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.

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.

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 Association of blood culture with carbapenem use in pyogenic liver abscess: a two-center retrospective study

2021 ◽  
Vol 21 (1) ◽  
Author(s):  
Shuangjun He ◽  
Jie Yu ◽  
Hairong Wang ◽  
Lifeng Wang ◽  
Yi Chen ◽  
...  
Keyword(s):  
Blood Culture ◽  
Liver Abscess ◽  
Bacterial Culture ◽  
Multivariate Analyses ◽  
Tertiary Care ◽  
Pyogenic Liver Abscess ◽  
Extended Spectrum Beta Lactamase ◽  
Tertiary Care Centers ◽  
High Positivity Rate ◽  
Positive Results

Abstract Background Highly empiric use of carbapenem in pyogenic liver abscess (PLA) is widespread problem. However, few studies have examined the association between blood culture and carbapenem use in patients with PLA in China. Thus, we conducted this observational study. Methods The data of patients diagnosed with PLA at two comprehensive tertiary care centers from 2014 to 2020 were retrospectively collected. Demographic and clinical data were analyzed, and univariate and multivariate analyses were performed to investigate the association between blood culture and carbapenem use. Subgroup analysis was conducted to explore whether the effect is different in sepsis. Results Blood culture was performed in 110 (46.0%) patients, of whom 44 (40.0%) patients had positive results for bacterial culture. Extended-spectrum beta-lactamase (ESBL)-positive blood culture isolates were detected in 8 (7.3%) patients. The positivity rate of blood culture in sepsis was higher than in non-sepsis (58.1% vs. 32.9%, P = 0.015). Fewer patients who had a blood culture received carbapenem treatment in comparison to patients without blood culture (19.1% vs. 31.8%, P = 0.026). Multivariate analysis showed that blood culture was independently associated with less carbapenem exposure (adjusted odds ratio [OR] = 0.33, 95% confidence interval [CI]: 0.16–0.68, P = 0.003), and this effect remained significant in the sepsis subgroup (adjusted OR = 0.17, 95% CI: 0.05–0.53, P = 0.002). Conclusion Blood culture had a high positivity rate and was associated with less carbapenem use in PLA, especially those who developed sepsis. More attention should be paid to performing early blood culture and less carbapenem use in PLA.

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

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.

Seated saline infusion test in predicting subtype diagnosis of primary aldosteronism

2019 ◽  
Vol 91 (6) ◽  
pp. 737-742 ◽  
Author(s):  
Hiroki Kaneko ◽  
Hironobu Umakoshi ◽  
Yuki Ishihara ◽  
Taku Sugawa ◽  
Kazutaka Nanba ◽  
...  
Keyword(s):  
Primary Aldosteronism ◽  
Saline Infusion ◽  
Infusion Test

Familial, Dexamethasone-Suppressible, Normokalemic Hyperaldosteronism

PEDIATRICS ◽  
1980 ◽  
Vol 65 (3) ◽  
pp. 597-604
Author(s):  
C. E. Grim ◽  
M. H. Weinberger
Keyword(s):  
Blood Pressure ◽  
Adrenocorticotropic Hormone ◽  
Plasma Renin ◽  
Plasma Aldosterone ◽  
Saline Infusion ◽  
Elevated Blood ◽  
Aldosterone Production ◽  
Renin Level ◽  
Dexamethasone Therapy ◽  
Low Levels

An 8-year-old boy was found to be hypertensive on routine exam (144/88). His brother (age 6) and father (age 31) were also found to have elevated blood pressure. Detailed investigations first revealed a low renin level without hypokalemia. Further study revealed that all three patients had low plasma renin activity and nonsuppresible plasma aldosterone levels after saline infusion. Serum potassium was almost always normal. A trial of dexamethasone therapy normalized blood pressure, and plasma and urinary aldosterone decreased to low levels and renin levels increased. Therapy with spironolactone and prednisone also normalized blood pressure. However, the amount of prednisone required to maintain normotension resulted in Cushingoid features and has been discontinued. Studies in the father suggest that the aldosterone production by his adrenals is hyperresponsive to adrenocorticotropic hormone (ACTH). Renin levels should be determined in all hypertensive children and their hypertensive parents. If renin is low and plasma aldosterone fails to be suppressed by saline infusion, a trial of dexamethasone would seem indicated before other investigations are carried out.

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