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

作者全名:"Hashimura, Hikaru; Hu, Jinbo; Kobayashi, Hiroki; Gwini, Stella May; Shen, Jimmy; Chee, Nicholas Y. N.; Doery, James C. G.; Chong, Winston; Fuller, Peter J.; Abe, Masanori; Li, Qifu; Yang, Jun"

作者地址:"[Hashimura, Hikaru; Shen, Jimmy; Chee, Nicholas Y. N.; Fuller, Peter J.; Yang, Jun] Monash Hlth, Dept Endocrinol, Clayton, Vic 3168, Australia; [Hu, Jinbo; Li, Qifu] Chongqing Med Univ, Dept Endocrinol, Affiliated Hosp, Chongqing 400016, Peoples R China; [Kobayashi, Hiroki; Abe, Masanori] Nihon Univ, Sch Med, Dept Internal Med, Div Nephrol Hypertens & Endocrinol, Tokyo 1028275, Japan; [Gwini, Stella May] Monash Univ, Sch Publ Hlth & Preventat Med, Clayton, Vic 3168, Australia; [Gwini, Stella May] Univ Hosp Geelong, Barwon Hlth, Dept Biostat, Geelong, Vic 3220, Australia; [Shen, Jimmy; Fuller, Peter J.; Yang, Jun] Hudson Inst Med Res, Ctr Endocrinol & Metab, Clayton, Vic 3168, Australia; [Doery, James C. G.] Monash Univ, Dept Med, Clayton, Vic 3168, Australia; [Doery, James C. G.] Monash Hlth, Dept Pathol, Clayton, Vic 3168, Australia; [Chong, Winston] Monash Hlth, Dept Imaging, Clayton, Vic 3168, Australia; [Yang, Jun] Monash Univ, Sch Clin Sci, Clayton, Vic 3168, Australia"

通信作者:"Yang, J (通讯作者),Hudson Inst, 27-31 Wright St, Clayton, Vic 3168, Australia."












关键词:primary aldosteronism; saline suppression test; recumbent; subtyping; adrenal vein sampling

摘要:"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."

基金机构:Victorian State Government Operational Infrastructure Scheme

基金资助正文:"We acknowledge the assistance of Ms Elise Forbes and Ms Peta Nuttall, our endocrine nurses who work tirelessly in the Endocrine Hypertension Clinic at Monash Health, Australia to ensure that all patients receive standardised blood pressure measurements and follow a streamlined investigative pathway. The Hudson Institute is supported by the Victorian State Government Operational Infrastructure Scheme."