Objective: The saline infusion test (SIT) is widely used as a confirmatory test for primary aldosteronism (PA). SIT results are judged as follows: post-test aldosterone levels !50 ng/l exclude PA, whereas levels O50 ng/l confirm PA. We hypothesized that post-SIT aldosterone concentrations indicate the severity of PA and might predict outcome. Design: The study includes 256 PA patients of the German Conn's Registry who prospectively underwent SIT. The data of 126 patients with complete follow-up of 1.2G0.3 years after diagnosis were analyzed. The patients were divided into two groups with post-SIT aldosterone levels of 50-100 ng/l (group 1; nZ38) and of O100 ng/l (group 2; nZ88). Results: Patients in group 2 had a significantly shorter duration of hypertension (7.5 vs 11.7 years (median), PZ0.014), higher systolic blood pressure (BP; 151G16 vs 143G17 mmHg, PZ0.036), lower serum potassium (3.3G0.6 vs 3.5G0.4 mmol/l, PZ0.006), higher 24-h urine protein excretion (7.4 vs 5.4 mg/dl (median), PZ0.012), and were more often female (PZ0.038). They showed more often unilateral disease (P!0.005) with larger tumors (14G10 vs 7G10 mm, PZ0.021), underwent more often adrenalectomy (75% vs 37%, P!0.005), required a lower number of antihypertensive drugs after adrenalectomy (1.2G1.2 vs 2.5G1.4, PZ0.001), had a faster normalization of urinary protein excretion (with medical treatment PZ0.049; with Adx P!0.005) at follow-up, and more frequently underlying well-characterized mutation (PZ0.047). Conclusions: PA patients with post-SIT aldosterone levels of O100 ng/l have a more rapid development of PA caused more frequently by unilateral disease with larger aldosterone-producing adenomas. However, this group of patients may have a significantly better outcome following specific treatment.
40-20-0 mg immediate release, but not modified release hydrocortisone, resulted in sufficient glucocorticoid coverage in patients with ACC receiving mitotane treatment. The use of equivalent doses of modified release hydrocortisone preparation should be avoided in patients on mitotane treatment.
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