Key result
Post-IV saline LC-MS/MS detects ~12-fold higher median aldosterone in primary aldosteronism patients versus those without.
Why the study?
Aldosterone levels associated with primary aldosteronism post-IV saline suppression using commercially available reference laboratory LC-MS/MS assays were unknown.
What are the aldosterone levels post-IV saline suppression using a commercial reference laboratory LC-MS/MS assay in patients with and without primary aldosteronism?
Observational (n=26)
What are the aldosterone levels post-IV saline suppression using a commercial reference laboratory LC-MS/MS assay in patients with and without primary aldosteronism?
Using a commercial LC-MS/MS assay, saline suppression testing in patients with confirmed primary aldosteronism can detect aldosterone levels as low as 4.0 ng/dl, differentiating them from patients without the condition.
Answers are grounded in this paper and cite their sources.
May inform commercial LC-MS/MS aldosterone thresholds for PA post-saline suppression; hypothesis-generating and requires prospective validation before clinical use.
Background/Objective: Diagnostic cutoffs for primary aldosteronism (PA) post-intravenous (IV) saline suppression have not been well established. These cutoffs are based on old immunoassays and, more recently, on liquid chromatography tandem mass spectrometry (LC-MS/MS) assays performed in research settings. Aldosterone levels associated with PA post-IV saline suppression using commercially available reference laboratory LC-MS/MS assays are unknown. Our objective was to report our experience measuring aldosterone levels postsaline infusion using a commercial reference laboratory LC-MS/MS assay. Methods: = 26) based on postsurgical outcomes (histopathology and PA surgical outcome criteria) and, for those on medical treatment, clinical and biochemical response to therapy. Aldosterone levels at baseline and after 2 L of IV normal saline infusion over 4 hours were analyzed and compared between the groups. The median aldosterone levels postsaline infusion in the confirmed PA group were 11.5 ng/dl (IQR: 8.0, 18.0) compared to 1.0 ng/dl (IQR: 1.0, 2.0) in the no PA group. In the latter, none of the patients had an aldosterone level >3.0 ng/dl. Conclusion: Using an LC-MS/MS aldosterone assay from a commercial reference laboratory, we report that saline suppression in patients with confirmed PA can detect aldosterone levels as low as 4.0 ng/dl. These results need to be confirmed with larger studies.
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Cardenas et al. (2025) conducted an observational in Primary aldosteronism (n=26). IV saline suppression vs. Patients without primary aldosteronism was evaluated on Median aldosterone levels postsaline infusion (ng/dl) (p=0.016). Post-IV saline suppression using a commercial LC-MS/MS assay detected median aldosterone levels of 11.5 ng/dl in confirmed primary aldosteronism patients compared to 1.0 ng/dl in those without.
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