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.

Confirmatory testing of primary aldosteronism with saline infusion test and LC-MS/MS

2020 ◽  
Author(s):  
Fuss Carmina Teresa ◽  
Katharina Brohm ◽  
Max Kurlbaum ◽  
Anke Hannemann ◽  
Sabine Kendl ◽  
...  
Keyword(s):  
Primary Aldosteronism ◽  
Saline Infusion ◽  
Infusion Test ◽  
Confirmatory Testing

scholarly journals THE VALUE OF HIGH EFFECTIVE LIQUID CHROMATOGRAPHYIN THE DIAGNOSIS OF PRIMARY HYPERALDOSTERONISM

2014 ◽  
Vol 6 (4) ◽  
pp. 21-25
Author(s):  
D V Rebrova ◽  
N V Vorokhobina ◽  
L I Velikanova
Keyword(s):  
Primary Aldosteronism ◽  
Cardiovascular Complications ◽  
Secondary Hypertension ◽  
Primary Hyperaldosteronism ◽  
Urine Samples ◽  
Uncontrolled Hypertension ◽  
Confirmatory Tests ◽  
Blood And Urine Samples ◽  
Diagnostic Criterion

Primary hyperaldosteronism is considered to be the most common cause of secondary hypertension. Therefore a relevance of early diagnosis of primary aldosteronism is obvious. The article discusses the possibility of using the determination of precursors of aldosterone in blood and urine samples by high effective liquid chromatography as an additional diagnostic criterion. The method is safe for the patients who have contraindications to recommended confirmatory tests. It can be used in patients with uncontrolled hypertension and high risk of cardiovascular complications. Our data showed that increased levels of blood corticosterone, 18-hydroxycorticosterone in blood and urine samples are laboratory signs of primary aldosteronism. We consider measurement of 18-hydroxycorticosterone blood level for early differential diagnosis of various types of primary aldosteronism.

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 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

scholarly journals Comparison of Clinical Features between Primary Aldosteronism and Essential Hypertension in Chinese Patients: A Case-Control Study

2021 ◽  
Vol 2021 ◽  
pp. 1-8
Author(s):  
Xiaoyu Huang ◽  
Shuang Yu ◽  
Huangmeng Xiao ◽  
Ling Pei ◽  
Yan Chen ◽  
...  
Keyword(s):  
Essential Hypertension ◽  
Insulin Secretion ◽  
Clinical Features ◽  
Primary Aldosteronism ◽  
Structural Damage ◽  
Case Control ◽  
Secondary Hypertension ◽  
Left Ventricular ◽  
Chinese Patients ◽  
Significant Difference

Primary aldosteronism (PA) is one of the most common forms of secondary hypertension. Recent studies suggest that, compared with essential hypertension (EH), PA presents more severe disorders of glycolipid metabolism and organ damages. This case-control retrospective study aimed to ascertain clinical features and metabolic parameters between Chinese patients of PA and EH. 174 PA patients and 174 matched EH patients were recruited. Their clinical features, biochemistry parameters, the ventricular septal thickness, and left ventricular mass index (LVMI) were compared. HOMA-β% and HOMA-IR were calculated to evaluate glucose metabolism. The results showed that there was no significant difference regarding BMI, waist-to-hip ratio, and blood pressure between the two groups. The blood potassium level was significantly lower in PA patients than those in EH patients. The abnormal glucose tolerance and the incidence of diabetes in the PA group were not significantly different from those in EH group, but the insulin secretion levels at 0 min and 30 min were significantly weaker than those in the EH group, and the HOMA-β% was also lower in the PA group than those in the EH group. Left ventricular structural abnormalities in PA patients were more severe than those in EH patients. Subtype analysis indicated that patient with aldosterone-producing adenoma (APA) has more serious hypokalemia and lower levels of HOMA-β% and HOMA-IR comparing to those in the idiopathic adrenal hyperplasia (IHA) patient. These findings demonstrated that PA patients showed more impaired insulin secretion function and more severe left ventricular structural damage compared with EH patients.

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.

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.

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