Biomaterial Database

Confirmatory Tests for the Diagnosis of Primary Aldosteronism: A Prospective Diagnostic Accuracy Study. 2018

Ying Song, and Shumin Yang, and Wenwen He, and Jinbo Hu, and Qingfeng Cheng, and Yue Wang, and Ting Luo, and Linqiang Ma, and Qianna Zhen, and Suhua Zhang, and Mei Mei, and Zhihong Wang, and Hua Qing, and Dennis Bruemmer, and Bin Peng, and Qifu Li, and

From the Department of Endocrinology, the First Affiliated Hospital of Chongqing Medical University (Y.S., S.Y., W.H., J.H., Q.C., Y.W., T.L., L.M., Q.Z., S.Z., M.M., Z.W., H.Q., Q.L.) and School of Public Health and Management, Chongqing Medical University (B.P.), China; and Division of Cardiology, Department of Medicine, Pittsburgh Heart, Lung, Blood, and Vascular Medicine Institute, University of Pittsburgh Medical Center, University of Pittsburgh School of Medicine, PA (D.B.).

The diagnosis of primary aldosteronism typically requires at least one confirmatory test. The fludrocortisone suppression test is generally accepted as a reliable confirmatory test, but it is cumbersome. Evidence from accuracy studies of the saline infusion test (SIT) and the captopril challenge test (CCT) has provided conflicting results. This prospective study aimed to evaluate the diagnostic accuracy of the SIT and CCT using fludrocortisone suppression test as the reference standard. One hundred thirty-five patients diagnosed with primary aldosteronism and 101 patients diagnosed with essential hypertension who completed the 3 confirmatory tests were included for the diagnostic accuracy analysis. The areas under the receiver-operator characteristics curves of the CCT and SIT were 0.96 (95% confidence interval [CI], 0.92-0.98) and 0.96 (95% CI, 0.92-0.98), respectively, using post-test plasma aldosterone concentration (PAC) for diagnosis. However, the areas under the receiver-operator characteristics curves of the CCT decreased to 0.71 (95% CI, 0.65-0.77) when the PAC suppression percentage was used to diagnose primary aldosteronism. The optimal cutoff of PAC post-CCT was set at 11 ng/dL, resulting in a sensitivity of 0.90 (95% CI, 0.84-0.95) and a specificity of 0.90 (95% CI, 0.83-0.95), which were not significantly different from those of SIT (with PAC post-SIT set at 8 ng/dL, sensitivity: 0.85 [95% CI, 0.78-0.91], P=0.192; specificity: 0.92 [95% CI, 0.85-0.97], P=0.551). In conclusion, both CCT and SIT are accurate alternatives to the more complex fludrocortisone suppression test. Because CCT is safe and much easier to perform, it may serve as a more feasible alternative. When interpreting the results of CCT, PAC post-CCT is highly recommended.

UI	MeSH Term	Description	Entries
D008297	Male		Males
D008875	Middle Aged	An adult aged 45 - 64 years.	Middle Age
D002216	Captopril	A potent and specific inhibitor of PEPTIDYL-DIPEPTIDASE A. It blocks the conversion of ANGIOTENSIN I to ANGIOTENSIN II, a vasoconstrictor and important regulator of arterial blood pressure. Captopril acts to suppress the RENIN-ANGIOTENSIN SYSTEM and inhibits pressure responses to exogenous angiotensin.	(S)-1-(3-Mercapto-2-methyl-1-oxopropyl)-L-proline,Capoten,Lopirin,SQ-14,225,SQ-14,534,SQ-14225,SQ-14534,SQ 14,225,SQ 14,534,SQ 14225,SQ 14534,SQ14,225,SQ14,534,SQ14225,SQ14534
D005260	Female		Females
D005438	Fludrocortisone	A synthetic mineralocorticoid with anti-inflammatory activity.	9-Fluorocortisol,9 alpha Fludrohydrocortisone,9 alpha-Fluoro-17-Hydroxycorticosterone,9 alpha-Fluorohydrocortisone,9-Fluoro-17-Hydroxycortisone,9-Fluorohydrocortisone,Astonin,Astonin Merck,Astonin-H,FCOL,9 Fluoro 17 Hydroxycortisone,9 Fluorocortisol,9 Fluorohydrocortisone,9 alpha Fluoro 17 Hydroxycorticosterone,9 alpha Fluorohydrocortisone,Astonin H,Merck, Astonin
D006801	Humans	Members of the species Homo sapiens.	Homo sapiens,Man (Taxonomy),Human,Man, Modern,Modern Man
D006929	Hyperaldosteronism	A condition caused by the overproduction of ALDOSTERONE. It is characterized by sodium retention and potassium excretion with resultant HYPERTENSION and HYPOKALEMIA.	Aldosteronism,Conn Syndrome,Conn's Syndrome,Primary Hyperaldosteronism,Conns Syndrome,Hyperaldosteronism, Primary,Syndrome, Conn,Syndrome, Conn's
D000075222	Essential Hypertension	Hypertension that occurs without known cause, or preexisting renal disease. Associated polymorphisms for a number of genes have been identified, including AGT, GNB3, and ECE1. OMIM: 145500	Primary Hypertension,Hypertension, Essential,Hypertension, Primary,Hypertensions, Primary,Primary Hypertensions
D000302	Adrenal Cortex	The outer layer of the adrenal gland. It is derived from MESODERM and comprised of three zones (outer ZONA GLOMERULOSA, middle ZONA FASCICULATA, and inner ZONA RETICULARIS) with each producing various steroids preferentially, such as ALDOSTERONE; HYDROCORTISONE; DEHYDROEPIANDROSTERONE; and ANDROSTENEDIONE. Adrenal cortex function is regulated by pituitary ADRENOCORTICOTROPIN.	Cortex, Adrenal
D000304	Adrenal Cortex Function Tests	Examinations that evaluate and monitor hormone production in the adrenal cortex.