A new highly sensitive and specific overnight combined screening and diagnostic test for primary aldosteronism
| Autor: | Labrini Papanastasiou, Eva Kassi, Aglaia Zachaki, George P. Chrousos, Athina Markou, Ioannis I. Androulakis, Nick Voulgaris, George Piaditis, Theodora Kounadi, Gregory Kaltsas, Vaios Tsiavos |
|---|---|
| Rok vydání: | 2016 |
| Předmět: |
Adult
Male medicine.medical_specialty Captopril Endocrinology Diabetes and Metabolism 030209 endocrinology & metabolism Context (language use) 030204 cardiovascular system & hematology Essential hypertension Sensitivity and Specificity Dexamethasone Renin-Angiotensin System 03 medical and health sciences chemistry.chemical_compound 0302 clinical medicine Endocrinology Primary aldosteronism Internal medicine Hyperaldosteronism Renin Humans Mass Screening Medicine Aldosterone Mass screening Aged Diagnostic Tests Routine business.industry General Medicine Middle Aged medicine.disease chemistry Valsartan Hypertension Spironolactone Female Pituitary-Adrenal Function Tests business medicine.drug |
| Zdroj: | European Journal of Endocrinology. 175:21-28 |
| ISSN: | 1479-683X 0804-4643 |
| Popis: | Context Primary aldosteronism (PA) is the most common cause of endocrine hypertension that is diagnosed following a two-step process: an initial screening test, based on the serum aldosterone-to-renin ratio (ARR), followed by a relatively laborious and time-consuming confirmatory test to document autonomous aldosterone (ALD) secretion. Objective The aim of this study is to develop a simple overnight test for the early and definite diagnosis of PA. Patients and methods Totally, 148 hypertensive patients underwent a fludrocortisone–dexamethasone suppression test (FDST) and the new overnight diagnostic test (DCVT) using pharmaceutical RAAS (renin–angiotensin–aldosterone system) blockade with dexamethasone, captopril and valsartan. Results Of the 148 patients, 45 were diagnosed as having PA and they all normalized their elevated blood pressure (BP) after administration of spironolactone or eplerenone. The remaining 103 patients were considered as having essential hypertension and served as controls. Using ROC analysis, the estimated sensitivity and specificity were 91 and 100%, respectively, for the post-FDST ARR, whereas 98% and 89% and 100% and 82% for the post-DCVT ARR and post-DCVT ALD, respectively, with selected cutoffs of 0.32ng/dL/μU/mL and 3ng/dL respectively. However, considering these cutoffs simultaneously, the estimated sensitivity and specificity were 98 and 100% respectively. Applying these cutoffs, the diagnosis of PA was confirmed in 44 (98%) of the 45 patients who were considered to have the disease. Conclusions In this study, a highly sensitive and specific, low-cost, rapid, safe, and easy-to-perform diagnostic test (DCVT) for PA is described, which could be utilized on an outpatient basis potentially substituting conventional laborious testing. |
| Databáze: | OpenAIRE |
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