Suppression of Aldosterone Secretion After Recumbent Saline Infusion Does Not Exclude Lateralized Primary Aldosteronism

Guidelines recommend suppression tests such as the saline infusion test (SIT) to ascertain the diagnosis of primary aldosteronism (PA) in patients with a high aldosterone:renin ratio. However, suppression tests have only been evaluated in small retrospective series, and some experts consider that th...

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Published in:Hypertension (Dallas, Tex. 1979) Tex. 1979), 2016-10, Vol.68 (4), p.989-994
Main Authors: Cornu, Erika, Steichen, Olivier, Nogueira-Silva, Luis, Küpers, Elselien, Pagny, Jean-Yves, Grataloup, Christine, Baron, Stéphanie, Zinzindohoue, Franck, Plouin, Pierre-François, Amar, Laurence
Format: Article
Language:English
Subjects:
Adrenalectomy - methods
Adult
Aldosterone - blood
Cohort Studies
Diagnostic Techniques, Endocrine
Female
France
Humans
Hyperaldosteronism - blood
Hyperaldosteronism - diagnosis
Hyperaldosteronism - surgery
Infusions, Intravenous
Male
Middle Aged
Patient Selection
Preoperative Care - methods
Prognosis
Renin - blood
Retrospective Studies
Sodium Chloride - administration & dosage
Treatment Outcome
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Summary:Guidelines recommend suppression tests such as the saline infusion test (SIT) to ascertain the diagnosis of primary aldosteronism (PA) in patients with a high aldosterone:renin ratio. However, suppression tests have only been evaluated in small retrospective series, and some experts consider that they are not helpful for the diagnosis of PA. In this study, we evaluated whether low post-SIT aldosterone concentrations do exclude lateralized PA. Between February 2009 and December 2013, 199 patients diagnosed with PA on the basis of 2 elevated aldosterone:renin ratio results and a high basal plasma or urinary aldosterone level or high post-SIT aldosterone level had a selective adrenal venous sampling. We used a selectivity index of 2 and a lateralization index of 4 to interpret the adrenal venous sampling results. Baseline characteristics of the patients were the following (percent or median): men 63%, 48 years old, office blood pressure 142/88 mm Hg, serum potassium 3.4 mmol/L, aldosterone:renin ratio 113 pmol/mU, plasma aldosterone concentration 588 pmol/L. The proportion of patients with lateralized adrenal venous sampling was 12 of 41 (29%) among those with post-SIT aldosterone
ISSN:0194-911X
1524-4563
DOI:10.1161/HYPERTENSIONAHA.116.07214