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Saline suppression test parameters may predict bilateral subtypes of primary aldosteronism
Author(s) -
Hashimura Hikaru,
Shen Jimmy,
Fuller Peter J.,
Chee Nicholas Y. N.,
Doery James C. G.,
Chong Winston,
Choy Kay Weng,
Gwini StellaMay,
Yang Jun
Publication year - 2018
Publication title -
clinical endocrinology
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 1.055
H-Index - 147
eISSN - 1365-2265
pISSN - 0300-0664
DOI - 10.1111/cen.13757
Subject(s) - primary aldosteronism , medicine , aldosterone , urology , endocrinology , cardiology
Summary Background The saline suppression test ( SST ) serves to confirm the diagnosis of primary aldosteronism ( PA ) whilst adrenal vein sampling ( AVS ) is used to determine whether the aldosterone hypersecretion is unilateral or bilateral. An accurate prediction of bilateral PA based on SST results could reduce the need for AVS . Aim We sought to identify SST parameters that reliably predict bilateral PA . Methods The results from 121 patients undergoing SST s at Monash Health from January 2010 to January 2018 including screening blood tests, imaging, AVS and histopathology results were evaluated. Patients were subtyped into unilateral or bilateral PA based on AVS and surgical outcomes. Results Of 113 patients with confirmed PA , 33 had unilateral disease whilst 42 had bilateral disease. In those with bilateral disease, plasma aldosterone concentration ( PAC ) was significantly lower post‐ SST , together with a significant fall in the aldosterone‐renin ratio ( ARR ). The combination of PAC < 300 pmol/L and a reduction in ARR post‐ SST provided 96.8% specificity in predicting bilateral disease. Eighteen of 39 patients (49%) with bilateral PA could have avoided AVS using these criteria. Conclusion A combination of PAC < 300 pmol/L and a lower ARR post‐ SST could reliably predict bilateral PA . An independent cohort will be needed to validate these findings.