Saline suppression to distinguish the primary aldosteronism subtype: a diagnostic study.

Autor:	Hashimura H; Department of Endocrinology, Monash Health, Clayton, VIC 3168, Australia., Hu J; Department of Endocrinology, The Affiliated Hospital of Chongqing Medical University, Chongqing 400016, China., Kobayashi H; Department of Internal Medicine, Division of Nephrology, Hypertension and Endocrinology, Nihon University School of Medicine, Tokyo 102-8275, Japan., Gwini SM; School of Public Health and Preventative Medicine, Monash University, Clayton, VIC 3168, Australia.; Department of Biostatistics, Barwon Health, University Hospital Geelong - Barwon Health, Geelong, VIC 3220, Australia., Shen J; Department of Endocrinology, Monash Health, Clayton, VIC 3168, Australia.; Centre of Endocrinology and Metabolism, Hudson Institute of Medical Research, Clayton, VIC 3168, Australia., Chee NYN; Department of Endocrinology, Monash Health, Clayton, VIC 3168, Australia., Doery JCG; Department of Medicine, Monash University, Clayton, VIC 3168, Australia.; Department of Pathology, Monash Health, Clayton, VIC 3168, Australia., Chong W; Department of Imaging, Monash Health, Clayton, VIC 3168, Australia., Fuller PJ; Department of Endocrinology, Monash Health, Clayton, VIC 3168, Australia.; Centre of Endocrinology and Metabolism, Hudson Institute of Medical Research, Clayton, VIC 3168, Australia., Abe M; Department of Internal Medicine, Division of Nephrology, Hypertension and Endocrinology, Nihon University School of Medicine, Tokyo 102-8275, Japan., Li Q; Department of Endocrinology, The Affiliated Hospital of Chongqing Medical University, Chongqing 400016, China., Yang J; Department of Endocrinology, Monash Health, Clayton, VIC 3168, Australia.; Centre of Endocrinology and Metabolism, Hudson Institute of Medical Research, Clayton, VIC 3168, Australia.; School of Clinical Sciences, Monash University, Clayton, VIC 3168, Australia.
Jazyk:	angličtina
Zdroj:	European journal of endocrinology [Eur J Endocrinol] 2023 Jan 10; Vol. 188 (1).
DOI:	10.1093/ejendo/lvac003
Abstrakt:	Objectives: The saline suppression test (SST) serves to confirm the diagnosis of primary aldosteronism (PA), while adrenal vein sampling (AVS) is used to subtype PA as unilateral or bilateral. Criteria that can accurately identify those with bilateral PA based on SST results could reduce the need for AVS. We previously demonstrated that a combination of plasma aldosterone concentration (PAC) < 300 pmol L-1 and a reduction in aldosterone-to-renin ratio (ARR) following recumbent SST had high specificity for predicting bilateral PA in an Australian cohort of 92 patients with PA who have undergone AVS. We sought to validate our predictive criteria in larger, independent cohorts of patients with PA. Design: An international, multi-centre cohort study. Methods: Data from 55 patients at Monash Health, Victoria, Australia, 106 patients from the First Affiliated Hospital of Chongqing Medical University, China, and 105 patients from Nihon University Itabashi Hospital, Japan were analysed. Results: A combination of PAC <300 pmol L-1 and a reduction in ARR following recumbent SST predicted bilateral PA with specificities of 88.2%, 97.0%, and 100.0% in Australian, Chinese, and Japanese cohorts, respectively. This criterion could allow 22%-38% of patients with PA to bypass AVS and proceed directly to medical treatment. Conclusion: In patients undergoing the recumbent SST, a post-saline PAC <300 pmol L-1 together with a reduction in ARR can predict bilateral PA with high specificity and may allow targeted treatment to be commenced without AVS in up to a third of patients. (© The Author(s) 2023. Published by Oxford University Press on behalf of (ESE) European Society of Endocrinology. All rights reserved. For permissions, please e-mail: journals.permissions@oup.com.)
Databáze:	MEDLINE
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