Kanran Wang 1 , Jinbo Hu 1 , Jun Yang 2,3 , Ying Song 1 , Peter J Fuller 2,3 , Hikaru Hashimura 2 , Wenwen He 1 , Zhengping Feng 1 , Qingfeng Cheng 1 , Zhipeng Du 1 , Zhihong Wang 1 , Linqiang Ma 1 , Shumin Yang 1 , Qifu Li 1 Show Affiliations »
Abstract
CONTEXT: The Endocrine Society Guidelines for the diagnosis of primary aldosteronism (PA) suggest that confirmatory tests (CFT) are not required when the following criteria are met: plasma aldosterone concentration (PAC) is >20 ng/dL, plasma renin is below detection levels, and hypokalemia is present. The evidence for the applicability of the guideline criteria is limited. OBJECTIVE: To develop and validate optimized criteria for sparing CFT in the diagnosis of PA. DESIGN AND SETTING: The optimized criteria were developed in a Chinese cohort using the captopril challenge test, verified by saline infusion test (SIT) and fludrocortisone suppression test (FST), and validated in an Australian cohort. PARTICIPANTS: Hypertensive patients who completed PA screening and CFT. MAIN OUTCOME MEASURE: Diagnostic value of the optimized criteria. RESULTS: In the development cohort (518 PA and 266 non-PA), hypokalemia, PAC, and plasma renin concentration (PRC) were selected as diagnostic indicators by multivariate logistic analyses. The combination of PAC >20 ng/dL plus PRC <2.5 μIU/mL plus hypokalemia had much higher sensitivity than the guideline criteria (0.36 vs 0.11). The optimized criteria remained superior when the SIT or FST were used as CFT. Non-PA patients were not misdiagnosed by either criteria, but the percentage of patients in whom CFT could be spared was higher with the optimized criteria. In the validation cohort (125 PA and 81 non-PA), the sensitivity of the optimized criteria was also significantly higher (0.12 vs 0.02). CONCLUSIONS: Hypertensive patients with PAC >20 ng/dL, PRC <2.5 μIU/mL, plus hypokalemia can be confidently diagnosed with PA without confirmatory tests. © Endocrine Society 2020. All rights reserved. For permissions, please e-mail: journals.permissions@oup.com.
CONTEXT: The Endocrine Society Guidelines for the diagnosis of primary aldosteronism (PA) suggest that confirmatory tests (CFT) are not required when the following criteria are met: plasma aldosterone concentration (PAC) is >20 ng/dL, plasma renin is below detection levels, and hypokalemia is present. The evidence for the applicability of the guideline criteria is limited. OBJECTIVE: To develop and validate optimized criteria for sparing CFT in the diagnosis of PA. DESIGN AND SETTING: The optimized criteria were developed in a Chinese cohort using the captopril challenge test, verified by saline infusion test (SIT) and fludrocortisone suppression test (FST), and validated in an Australian cohort. PARTICIPANTS: Hypertensive patients who completed PA screening and CFT. MAIN OUTCOME MEASURE: Diagnostic value of the optimized criteria. RESULTS: In the development cohort (518 PA and 266 non-PA), hypokalemia, PAC, and plasma renin concentration (PRC) were selected as diagnostic indicators by multivariate logistic analyses. The combination of PAC >20 ng/dL plus PRC <2.5 μIU/mL plus hypokalemia had much higher sensitivity than the guideline criteria (0.36 vs 0.11). The optimized criteria remained superior when the SIT or FST were used as CFT. Non-PA patients were not misdiagnosed by either criteria, but the percentage of patients in whom CFT could be spared was higher with the optimized criteria. In the validation cohort (125 PA and 81 non-PA), the sensitivity of the optimized criteria was also significantly higher (0.12 vs 0.02). CONCLUSIONS: Hypertensive patients with PAC >20 ng/dL, PRC <2.5 μIU/mL, plus hypokalemia can be confidently diagnosed with PA without confirmatory tests. © Endocrine Society 2020. All rights reserved. For permissions, please e-mail: journals.permissions@oup.com.
Entities: Chemical
Keywords:
optimized criteria; primary aldosteronism; sensitivity; sparing confirmation; specificity
Mesh： See more »
Year: 2020
PMID： 32449927 DOI： 10.1210/clinem/dgaa282
Source DB: PubMed Journal: J Clin Endocrinol Metab ISSN： 0021-972X Impact factor: 5.958