Reassessment of Postural Stimulation Testing as a Simple Tool to Identify a Subgroup of Patients With Unilateral Primary Aldosteronism
| Autor: | Katharina Brohm, Stefanie Hahner, Matthias Kroiss, Carmina Teresa Fuss, Martin Fassnacht |
|---|---|
| Rok vydání: | 2021 |
| Předmět: |
Adult
Male medicine.medical_specialty Hydrocortisone Endocrinology Diabetes and Metabolism Clinical Biochemistry Urology Context (language use) Stimulation Biochemistry Cohort Studies Diagnosis Differential Endocrinology Primary aldosteronism Internal medicine Hyperaldosteronism Renin medicine Humans Online Only Articles Aldosterone Clinical Research Articles bilateral hyperplasia Aged Retrospective Studies adrenal vein sampling Blood Specimen Collection Receiver operating characteristic business.industry Biochemistry (medical) Guideline Gold standard (test) Middle Aged medicine.disease aldosterone-producing adenoma Standing Position Female Differential diagnosis business AcademicSubjects/MED00250 Cohort study |
| Zdroj: | The Journal of Clinical Endocrinology and Metabolism |
| ISSN: | 1945-7197 0021-972X |
| DOI: | 10.1210/clinem/dgab611 |
| Popis: | Context Adrenal vein sampling (AVS) represents the current diagnostic gold standard for differentiation between unilateral and bilateral primary aldosteronism (PA). Postural stimulation testing (PST) has been used to provide additional diagnostic information. Objective This work aimed to evaluate the diagnostic utility of PST in the differential diagnosis of PA. Methods This cohort study was conducted at a single tertiary reference center. We analyzed 106 PST performed between 2008 and 2020. Diagnosis of PA and cause of PA were determined according to the Endocrine Society Clinical Practice Guideline, taking into account results of saline infusion testing, AVS, preoperative imaging, and outcome after medical or surgical treatment. The suggested cutoffs for the diagnosis of unilateral PA were revisited and optimized for high specificity using receiver operating characteristics (ROC) analysis. Results A total of 106 patients had confirmed PA (unilateral PA: n = 55, bilateral PA: n = 29, AVS unsuccessful/declined by patients: n = 22). Based on decreased aldosterone plasma concentration of 28% or more after 4 hours in the upright position, the PST showed a sensitivity of 36.4% at a specificity of 100% to identify unilateral disease (area under the curve [AUC] = 0.72; 95% CI, 0.62-0.83; P = .001). In patients with valid testing (drop of cortisol of 10% or more after 4 hours, n = 53) the sensitivity of PST rose to 51.4% at a specificity of 100% (AUC = 0.77; 95% CI, 0.65-0.90; P = .001). Conclusion The high specificity of 100% for the detection of unilateral PA in patients with decreased aldosterone by at least 28% after 4 hours makes PST a simple, noninvasive contribution to subtype differentiation in PA. |
| Databáze: | OpenAIRE |
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