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Analysis of screening and confirmatory tests in the diagnosis of primary aldosteronism: need for a standardized protocol

Giacchetti, Gilberta ; Ronconi, Vanessa ; Lucarelli, Giulio ; Boscaro, Marco ; Mantero, Franco

Journal of hypertension, 2006-04, Vol.24 (4), p.737-745 [Periódico revisado por pares]

England: Lippincott Williams & Wilkins, Inc

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  • Título:
    Analysis of screening and confirmatory tests in the diagnosis of primary aldosteronism: need for a standardized protocol
  • Autor: Giacchetti, Gilberta ; Ronconi, Vanessa ; Lucarelli, Giulio ; Boscaro, Marco ; Mantero, Franco
  • Assuntos: Aldosterone - blood ; Aldosterone - urine ; Diagnostic Tests, Routine - methods ; Female ; Humans ; Hyperaldosteronism - blood ; Hyperaldosteronism - diagnosis ; Male ; Mass Screening ; Middle Aged ; Radioimmunoassay - methods ; Renin - blood ; Sensitivity and Specificity
  • É parte de: Journal of hypertension, 2006-04, Vol.24 (4), p.737-745
  • Notas: ObjectType-Article-1
    SourceType-Scholarly Journals-1
    ObjectType-Feature-2
    content type line 23
  • Descrição: BACKGROUNDThe upright serum aldosterone/upright plasma renin activity ratio (ARR) has been recommended as a screening tool for the diagnosis of primary aldosteronism. OBJECTIVEWe reviewed the data collected from hypertensive patients in order to define retrospectively the cut-off values and evaluate the reliability of the ARR and of the saline infusion test in the diagnosis of primary aldosteronism. PATIENTSIn 157 patients referred to our unit with a suspicion of primary aldosteronism, 61 of whom had confirmed primary aldosteronism [26 aldosterone-producing adenoma (APA); 35 idiopathic hyperaldosteronism], the supine and upright ARR, and the ARR after the administration of captopril and losartan were calculated, and the results of the saline infusion test were analysed. RESULTSChoosing 40 as the cut-off value, the upright ARR had 100% sensitivity and 84.4% specificity. The post-captopril and post-losartan ARR were slightly more specific, but at the cost of a lower sensitivity. A cut-off value of 7 ng/dl for serum aldosterone at the end of the saline infusion in patients with an upright ARR of 40, gave 100% specificity and a positive predictive value. Furthermore, APA patients showed increased mean levels of aldosterone/cortisol ratio after the saline infusion test. CONCLUSIONOur data reinforce the superiority of a standardized upright ARR as a screening test in the diagnosis of primary aldosteronism, identifying 40 as an ideal cut-off value. Saline infusion represents a useful test to confirm such a diagnosis, with a serum aldosterone level of 7 ng/dl as a satisfactory cut-off value. Some more information is obtained when the aldosterone/cortisol ratio is considered.
  • Editor: England: Lippincott Williams & Wilkins, Inc
  • Idioma: Inglês
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  • Realização: ABCD-USP USP   Logos de Redes Sociais: Freepik

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