Key result
A post-saline PAC <300 pmol L-1 combined with a reduction in ARR predicted bilateral primary aldosteronism with specificities of 88.2%, 97.0%, and 100.0% in Australian, Chinese, and Japanese cohorts.
Why the study?
The authors sought to validate previously derived predictive criteria using the recumbent saline suppression test to identify bilateral primary aldosteronism and potentially reduce the need for adrenal vein sampling.
Does a combination of post-saline PAC <300 pmol/L and ARR reduction during recumbent SST accurately predict bilateral primary aldosteronism in patients with PA?
Cohort (n=266)
Yes
Does a combination of post-saline PAC <300 pmol/L and ARR reduction during recumbent SST accurately predict bilateral primary aldosteronism in patients with PA?
A post-saline PAC <300 pmol/L combined with a reduction in ARR during recumbent SST can predict bilateral primary aldosteronism with high specificity, potentially allowing up to a third of patients to bypass adrenal vein sampling.
SST criteria may reduce AVS in select PA patients; leaves open prospective validation before practice change.
OBJECTIVES: The saline suppression test (SST) serves to confirm the diagnosis of primary aldosteronism (PA), while adrenal vein sampling (AVS) is used to subtype PA as unilateral or bilateral. Criteria that can accurately identify those with bilateral PA based on SST results could reduce the need for AVS. We previously demonstrated that a combination of plasma aldosterone concentration (PAC) < 300 pmol L-1 and a reduction in aldosterone-to-renin ratio (ARR) following recumbent SST had high specificity for predicting bilateral PA in an Australian cohort of 92 patients with PA who have undergone AVS. We sought to validate our predictive criteria in larger, independent cohorts of patients with PA. DESIGN: An international, multi-centre cohort study. METHODS: Data from 55 patients at Monash Health, Victoria, Australia, 106 patients from the First Affiliated Hospital of Chongqing Medical University, China, and 105 patients from Nihon University Itabashi Hospital, Japan were analysed. RESULTS: A combination of PAC <300 pmol L-1 and a reduction in ARR following recumbent SST predicted bilateral PA with specificities of 88.2%, 97.0%, and 100.0% in Australian, Chinese, and Japanese cohorts, respectively. This criterion could allow 22%-38% of patients with PA to bypass AVS and proceed directly to medical treatment. CONCLUSION: In patients undergoing the recumbent SST, a post-saline PAC <300 pmol L-1 together with a reduction in ARR can predict bilateral PA with high specificity and may allow targeted treatment to be commenced without AVS in up to a third of patients.
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Hashimura et al. (2023) conducted a cohort in Primary aldosteronism (n=266). Post-saline PAC <300 pmol L-1 and reduction in ARR was evaluated on Specificity for predicting bilateral primary aldosteronism. A post-saline PAC <300 pmol L-1 combined with a reduction in ARR predicted bilateral primary aldosteronism with specificities of 88.2%, 97.0%, and 100.0% in Australian, Chinese, and Japanese cohorts.
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