Key result
Overnight dexamethasone boosts primary aldosteronism screening interpretability by ~31 percentage points over conventional testing.
Why the study?
Screening for primary aldosteronism remains low despite contributing to hypertension in up to 20% of patients, conventionally requiring withdrawal of RAAS-interfering medications.
Does overnight 1 mg dexamethasone improve the diagnostic interpretability of aldosterone-to-renin ratio screening for primary aldosteronism in patients with hypertension on interfering therapy?
Cross-Sectional (n=240)
No
Does overnight 1 mg dexamethasone improve the diagnostic interpretability of aldosterone-to-renin ratio screening for primary aldosteronism in patients with hypertension on interfering therapy?
An optimized overnight dexamethasone screening protocol may significantly reduce indeterminate aldosterone-to-renin ratio results in patients tested for primary aldosteronism without completely withdrawing anti-hypertensive therapy.
May support dexamethasone-enhanced PA screening on interfering meds; leaves open prospective validation before practice change.
Screening for primary aldosteronism (PA) remains exceedingly low, despite the fact that the disorder contributes to or underlies hypertension (HT) in as many as 20% of unselected patients. Conventionally, withdrawal of medications interfering with the renin‒angiotensin‒aldosterone system (RAAS) has been recommended before PA work-up. Previous research showed that combining objective thresholds and 2-day cosyntropin suppression was highly accurate in diagnosing PA among HT patients off interfering drugs. Here, we present the protocol of a study designed to generate and temporally validate aldosterone-to-renin ratio (ARR) thresholds following overnight cosyntropin suppression in PA screening on interfering medications. We hypothesize that overnight cosyntropin suppression with 1 mg dexamethasone will result in 25% higher diagnostic interpretability compared to conventional ARR testing. This single-center study consists of a development and confirmation cohort (both n = 80). Patients with an adrenal incidentaloma are enrolled in a 1-day clinic. Aldosterone-to-renin ratios (ARRs) are determined before and after overnight intake of 1 mg dexamethasone (DXM) on, partially off, and off medications interfering with the RAAS. Emphasis on screening and limitation of PA confirmatory (suppression) tests have been included in the current Endocrine Society guideline on PA due to low evidence of benefits of the latter in diagnosing the disorder. In light of poor PA screening rates, the ODEPRASC study may provide a rationale for an optimized diagnostic approach. Trial Registration: ClinicalTrials.gov identifier: NCT06740838.
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Kmieć et al. (2025) conducted a cross-sectional in Hypertension with adrenal incidentaloma (Primary Aldosteronism screening) (n=240). Overnight 1 mg dexamethasone prior to aldosterone-to-renin ratio (ARR) testing vs. Conventional baseline ARR testing without overnight dexamethasone was evaluated on Diagnostic interpretability (proportion of clear positive/negative screening results vs equivocal results) (31% higher interpretability). In preliminary pilot data of 19 patients, overnight dexamethasone improved the diagnostic interpretability of primary aldosteronism screening by 31% (from 42% pre-dexamethasone to 73% post-dexamethasone) compared to conventional testing.
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