Comparison of Seated With Recumbent Saline Suppression Testing for the Diagnosis of Primary Aldosteronism
| Autor: | Michael Stowasser, Ashraf H. Ahmed, Diane Cowley, Brett McWhinney, Martin Wolley, Richard D. Gordon, Jacobus P.J. Ungerer, Zeng Guo |
|---|---|
| Rok vydání: | 2018 |
| Předmět: |
Adult
Male medicine.medical_specialty Validation study Supine position Endocrinology Diabetes and Metabolism medicine.medical_treatment Fludrocortisone Clinical Biochemistry 030209 endocrinology & metabolism Pilot Projects 030204 cardiovascular system & hematology Biochemistry Patient Positioning Diagnostic Techniques Endocrine 03 medical and health sciences chemistry.chemical_compound 0302 clinical medicine Endocrinology Primary aldosteronism Internal medicine Hyperaldosteronism medicine Supine Position Humans Saline Aldosterone Aged Aged 80 and over Sitting Position Receiver operating characteristic business.industry Biochemistry (medical) Middle Aged medicine.disease Adrenal venous sampling chemistry ROC Curve Cardiology Female Saline Solution business human activities medicine.drug |
| Zdroj: | The Journal of clinical endocrinology and metabolism. 103(11) |
| ISSN: | 1945-7197 |
| Popis: | Failure of plasma aldosterone suppression during fludrocortisone suppression testing (FST) or saline suppression testing (SST) confirms primary aldosteronism (PA). Aldosterone is often higher upright than recumbent in PA; upright levels are used during FST. In a pilot study (24 patients with PA), seated saline suppression testing (SSST) was more sensitive than recumbent saline suppression testing (RSST).The current validation study involved 100 patients who underwent FST, RSST, and SSST, eight before and after unilateral adrenalectomy. Of the 108 FSTs, 73 confirmed and 18 excluded PA. Four patients with inconclusive FST lateralized on adrenal venous sampling, making a total of 77 with PA.The area under the receiver operating characteristic (ROC) curve was greater for SSST than RSST (0.96 vs. 0.80; P0.01). ROC analysis predicted optimal cutoff aldosterone levels of 162 pmol/L for SSST and 106 pmol/L for RSST. At these cutoffs, SSST showed high sensitivity for PA (87%) that markedly exceeded that for RSST (38%; P0.001) but similar specificity (94 vs. 94%; not significant). SSST was more sensitive than RSST in detecting both unilateral (n = 28, 93% vs. 68%, P0.05) and bilateral (n = 40, 85% vs. 20%, P0.001) forms of PA. Only three SSST (vs. 9 RSST and 17 FST) results were inconclusive.SSST is highly sensitive and superior to RSST in identifying both unilateral and bilateral forms of PA and has a low rate of false positives and inconclusive results. It therefore offers a reliable and much less complicated and expensive alternative to FST for confirming PA. |
| Databáze: | OpenAIRE |
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