scholarly journals MON-192 Comparison of the Seated and Recumbent Saline Infusion Test for the Diagnosis of Primary Aldosteronism in Chinese Population

2020 ◽  
Vol 4 (Supplement_1) ◽  
Author(s):  
Dan Zhang ◽  
Tao Chen ◽  
Haoming Tian ◽  
Yuanmei Li ◽  
Dan Mo ◽  
...  
Keyword(s):  
Primary Aldosteronism ◽  
Operating Characteristic ◽  
Saline Infusion ◽  
Youden Index ◽  
Infusion Test ◽  
Subtype Classification ◽  
Aldosterone Producing Adenoma ◽  
Preliminary Study ◽  
Better Than

Abstract Background: None of the diagnostic tests for primary aldosteronism (PA) are ideal according to the current literature. In a preliminary study, the seated saline infusion test (SSIT) was more sensitive than the recumbent saline infusion test (RSIT) for the diagnosis and subtype classification of PA. However, it is unclear whether the SSIT is suitable for Chinese PA patients. Objective: We prospectively investigated the accuracy of the seated saline infusion test (SSIT) in 113 patients with hypertension (including 93 PA and 20 essential hypertension (EH) patients) in the Department of Endocrinology and Metabolism. Approach and Results: Each patient underwent an recumbent saline infusion test (RSIT) and seated saline infusion test (SSIT). The accuracy of the SSIT for a confirmative primary aldosteronism (PA) diagnosis and subtype classification was evaluated and compared with the RSIT. The area under the receiver operating characteristic (ROC) curve (AUC) of aldosterone for the SSIT was significantly greater than that for the RSIT (0.945±0.0199 vs 0.828±0.0404; P<0.05). The ROC analysis showed that the optimal plasma aldosterone cutoff values were 12.94 ng/dl for the SSIT (sensitivity 86.02%, specificity 95%; Youden index (YI)=0.810) and 12.04 ng/dl for the RSIT (sensitivity 83.15%, specificity 57%; Youden index (YI)=0.401). The optimal aldosterone concentration cutoff value for classifying aldosterone-producing adenoma (APA) and idiopathic hyperaldosteronism (IHA) was 18.12 ng/dl for the SSIT (sensitivity 73.5%, specificity 79.5%). No patients experienced adverse events during the SSIT. Conclusions: The SSIT was safe and convenient for PA diagnosis. The accuracy of the SSIT for a confirmatory diagnosis of PA was better than that of the RSIT. The SSIT is a reliable alternative for PA confirmation in Chinese individuals.

EXPLORATION OF THE SEATED SALINE SUPPRESSION TEST FOR THE DIAGNOSIS OF PRIMARY ALDOSTERONISM IN THE CHINESE POPULATION

2020 ◽  
Vol 26 (8) ◽  
pp. 891-899 ◽  
Author(s):  
Dan Zhang ◽  
Tao Chen ◽  
Haoming Tian ◽  
Yuanmei Li ◽  
Dan Mo ◽  
...  
Keyword(s):  
Essential Hypertension ◽  
Receiver Operating Characteristic ◽  
Primary Aldosteronism ◽  
Operating Characteristic ◽  
Plasma Aldosterone ◽  
Youden Index ◽  
Plasma Aldosterone Concentration ◽  
Suppression Test ◽  
Aldosterone Producing Adenoma ◽  
Idiopathic Hyperaldosteronism

Objective: We prospectively investigated the accuracy of the seated saline suppression test (SSST) in 113 patients with hypertension (including 93 primary aldosteronism [PA] and 20 essential hypertension patients) in the Department of Endocrinology and Metabolism. Methods: Each patient underwent a recumbent saline suppression test (RSST) and SSST. The accuracy of the SSST for a confirmative PA diagnosis and subtype classification was evaluated and compared with the RSST. Results: The area under the receiver operating characteristic (ROC) curve of plasma aldosterone concentration (PAC) for the SSST was significantly greater than that for the RSST (0.945 ± 0.0199 vs. 0.828 ± 0.0404; P<.05). The ROC analysis showed that the optimal PAC cut-off values were 12.94 ng/dL for the SSST (sensitivity 86.02%, specificity 95%; Youden index [YI] 0.810) and 12.04 ng/dL for the RSST (sensitivity 83.15%, specificity 57%; YI 0.401). The optimal PAC cut-off value for classifying aldosterone-producing adenoma and idiopathic hyperaldosteronism was 18.12 ng/dL for the SSST (sensitivity 73.5%, specificity 79.5%). No patients experienced adverse events during the SSST. Conclusion: The SSST is safe and convenient for PA diagnosis. The accuracy of the SSST for a confirmatory diagnosis of PA was better than that of the RSST. The SSST is a reliable alternative for PA confirmation in Chinese individuals. Abbreviations: APA = aldosterone-producing adenoma; ARR = aldosterone to renin ratio; AVS = adrenal vein sampling; CT = computed tomography; EH = essential hypertension; IHA = idiopathic hyperaldosteronism; MRI = magnetic resonance imaging; PA = primary aldosteronism; PAC = plasma aldosterone concentration; PRA = plasma renin activity; ROC = receiver operating characteristic; RSST = recumbent saline suppression test; SSST = seated saline suppression test; YI = Youden index

Prospective evaluation of the saline infusion test for excluding primary aldosteronism due to aldosterone-producing adenoma

2007 ◽  
Vol 25 (7) ◽  
pp. 1433-1442 ◽  
Author(s):  
Gian Paolo Rossi ◽  
Anna Belfiore ◽  
Giampaolo Bernini ◽  
Giovambattista Desideri ◽  
Bruno Fabris ◽  
...  
Keyword(s):  
Primary Aldosteronism ◽  
Saline Infusion ◽  
Infusion Test ◽  
Prospective Evaluation ◽  
Aldosterone Producing Adenoma

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

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 Functional imaging with 11C-metomidate PET for subtype diagnosis in primary aldosteronism

2020 ◽  
Vol 183 (6) ◽  
pp. 539-550
Author(s):  
Minna Soinio ◽  
Anna-Kaarina Luukkonen ◽  
Marko Seppänen ◽  
Jukka Kemppainen ◽  
Janne Seppänen ◽  
...  
Keyword(s):  
Functional Imaging ◽  
Primary Aldosteronism ◽  
Standardized Uptake Value ◽  
Random Order ◽  
Operating Characteristics ◽  
Endocrine Society ◽  
Subtype Classification ◽  
Characteristics Analysis ◽  
Adrenal Ct

Objective Endocrine Society guidelines recommend adrenal venous sampling (AVS) in primary aldosteronism (PA) if adrenalectomy is considered. We tested whether functional imaging of adrenal cortex with 11C-metomidate (11C-MTO) could offer a noninvasive alternative to AVS in the subtype classification of PA. Design We prospectively recruited 58 patients with confirmed PA who were eligible for adrenal surgery. Methods Subjects underwent AVS and 11C-MTO-PET without dexamethasone pretreatment in random order. The lateralization of 11C-MTO-PET and adrenal CT were compared with AVS in all subjects and in a prespecified adrenalectomy subgroup in which the diagnosis was confirmed with immunohistochemical staining for CYP11B2. Results In the whole study population, the concordance of AVS and 11C-MTO-PET was 51% and did not differ from that of AVS and adrenal CT (53%). The concordance of AVS and 11C-MTO-PET was 55% in unilateral and 44% in bilateral PA. In receiver operating characteristics analysis, the maximum standardized uptake value ratio of 1.16 in 11C-MTO-PET had an AUC of 0.507 (P = n.s.) to predict allocation to adrenalectomy or medical therapy with sensitivity of 55% and specificity of 44%. In the prespecified adrenalectomy subgroup, AVS and 11C-MTO-PET were concordant in 10 of 19 subjects with CYP11B2-positive adenoma and in 6 of 10 with CYP11B2-positivity without an adenoma. Conclusions The concordance of 11C-MTO-PET with AVS was clinically suboptimal, and did not outperform adrenal CT. In a subgroup with CYP11B2-positive adenoma, 11C-MTO-PET identified 53% of cases. 11C-MTO-PET appeared to be inferior to AVS for subtype classification of PA.

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
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