Clinical evaluation of the captopril screening test for primary aldosteronism.

Naomi, Shojiro; Iwaoka, Taisuke; Umeda, Teruhisa; Inoue, Junnosuke; Hamasaki, Shinichiro; Miura, Fumihiro; Fujii, Yoshitaka; Satô, Tatsuo

doi:10.1536/ihj.26.549

Cited by 25 publications

(26 citation statements)

References 8 publications

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“…12 Because the test was simple and specific, it was thought that it might also be superior as a screening test. 15 However, subsequent investigations did not show superiority over criteria using basal plasma aldosterone combined with the aldosterone/renin ratio, but it was equally efficacious. 16,17 Wambach et al 18 observed a larger fall in plasma aldosterone levels after captopril administration in 16 patients with bilateral adrenal hyperplasia compared with 8 patients with unique adenoma.…”

Section: Discussionmentioning

confidence: 98%

Captopril Suppression Versus Salt Loading in Confirming Primary Aldosteronism

et al. 2001

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Abstract-This prospective study was designed to compare the captopril suppression test with the salt-loading approach to confirm the diagnosis of primary aldosteronism. A total of 49 patients were referred with a presumed diagnosis of primary aldosteronism. The captopril test was performed in the morning with patients in the seated position after overnight fasting. Blood samples for plasma aldosterone were obtained before captopril administration (25 mg PO) and again 2 hours later. Patients were then subjected to a high salt diet (300 mmol sodium per day for 3 days). On the third day, urinary sodium (24 hours) was measured, and plasma aldosterone levels were measured at 8:00 AM (recumbent) and at noon (standing). Of the 49 patients, 44 had nonsuppressible aldosterone concentrations with all the clinical characteristics of primary aldosteronism: 22 patients had surgically confirmed unique adenoma, and 22 patients had presumed bilateral hyperplasia. There was a significant correlation between plasma aldosterone values of salt-loaded patients (mean of 8:00 AM and noon results) and the values 2 hours after captopril administration (rϭ0.8, PϽ0.01). Plasma aldosterone cumulative distribution curves in primary aldosteronism patients (adenoma and hyperplasia) were not significantly different between the 2 suppression tests. Our results showed that the captopril suppression test is as effective as sodium loading in confirming the diagnosis of primary aldosteronism.

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Section: Discussionmentioning

confidence: 98%

Captopril Suppression Versus Salt Loading in Confirming Primary Aldosteronism

et al. 2001

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“…2,5,13,23 K Clinical conditions at time of testing can obscure both the screening and diagnosis of PHA and therefore influence the prevalence rate. 5,[19][20][21][22][23][24][25] What this study contributes K After controlling for several known confounders including dietary sodium and potassium, posture, medication, circadian rhythms and using a normotensive control population we found the prevalence of PHA in the majority of essential hypertensives (those with mild to moderate hypertension without hypokalaemia) to be 3.2%. K At a prevalence of 3.2%, screening for PHA in this population might lead to a high false-positive rate.…”

Section: Discussionmentioning

confidence: 99%

“…This variability contributes to a considerably high falsepositive rate of 6-25% with general application. 24,25 Determining an accurate prevalence rate for PHA in the non-referral, mild to moderate hypertensive population might have practical significance since a low rate would influence pretest probability and selection for screening. Therefore, the aim of this study was to examine the prevalence of PHA in a diverse population of hypertensive patients without resistant hypertension or hypokalaemia -those with mild to moderate hypertension.…”

Section: Introductionmentioning

confidence: 99%

Prevalence of primary hyperaldosteronism in mild to moderate hypertension without hypokalaemia

et al. 2005

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Screening for primary hyperaldosteronism (PHA) is often indicated in individuals with resistant hypertension or hypokalaemia. However, in the far larger subset of the hypertensive population who do not fit into these criteria, the evidence for screening is conflicting and dependent on the disease prevalence. The purpose of this study was to examine the prevalence of PHA in a large population with mild to moderate hypertension and without hypokalaemia using a carefully controlled study protocol including a normotensive control population. Hypertensive subjects underwent medication washout and both hypertensive and normotensive subjects placed on a high-sodium diet prior to biochemical and haemodynamic testing. Study specific cutoff values were based on results from the normotensive population studied under identical conditions. A screening test (serum aldosterone/PRA ratio [ARR]425 with a serum aldosterone level 48 ng/dl) was followed by a confirmatory test (urine aldosterone excretion rate [AER] 417 lg/ 24 h) to demonstrate evidence of PHA. An elevated ARR with a concomitant elevated serum aldosterone was present in 26 (7.5%) individuals. Of these, 11 (3.2%) had an elevated AER, consistent with evidence of PHA. Individuals with PHA had higher blood pressure and lower serum potassium levels while on a high-sodium diet. Sodium restriction neutralized these differences between PHA and essential hypertensives. The prevalence of PHA in this mild to moderate hypertensive population without hypokalaemia is at most 3.2%, a rate that might lead to excessive false positives with random screening in comparable populations. Hyperaldosteronism, when present, is responsive to sodium restriction.

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“…To definitely diagnose primary aldosteronism, adrenal venous sampling before and 30 min after adrenocorticotrophic hormone (ACTH) stimulation was performed according to the method reported previously 4) . Basal aldosterone levels in right and left adrenal veins were 387 and 107 ng/dL, respectively, which rose to 1,843 and 748 5,6) . Parentheses show normal range of each hormone.…”

Section: Case Presentationmentioning

confidence: 89%

Successful treatment of a mycotic aortic pseudoaneurysm in a patient with type 2 diabetes mellitus while treating primary aldosteronism with spironolactone

Ito

Yoshimura

Matsuzawa

et al. 2010

JAT

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We describe a diabetic patient successfully treated for an acute mycotic aortic arch pseudoaneurysm with primary aldosteronism. The patient first complained of severe pain in the left upper extremity and left back with high C reactive protein (CRP) and high-grade fever. It was suspected that acute aortic dissection had developed in association with mycotic pseudoaneurysm of the aortic arch because of chest X-ray findings of enlargement of the aortic arch. Computed tomography (CT) of the aortic arch revealed an aortic aneurysm protruding in the superior direction. Staphylococcus aureus was detected in blood culture, suggesting a mycotic aortic aneurysm, and artificial blood vessel replacement of the aortic arch was performed. Intraoperative findings suggested aortic pseudoaneurysm, which consisted of mediastinal rupture of the aorta at the distal arch. Our patient had a 2-year history of type 2 diabetes mellitus and poor blood sugar control, even with twice-daily injection of insulin. Blood pressure was not always well controlled because of primary aldosteronism. Thus, it was speculated that hyperaldosteronism, as well as diabetes-associated atherosclerosis, had persisted for a long time. No reports have described mycotic pseudoaneurysm in the aortic arch in a diabetic patient associated with primary aldosteronism. It is necessary to note that serious vascular complications are possible if aldosteronism is left untreated or is treated insufficiently as essential hypertension. J Atheroscler Thromb, 2010; 17:771-775.

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Clinical evaluation of the captopril screening test for primary aldosteronism.

Cited by 25 publications

References 8 publications

Captopril Suppression Versus Salt Loading in Confirming Primary Aldosteronism

Captopril Suppression Versus Salt Loading in Confirming Primary Aldosteronism

Prevalence of primary hyperaldosteronism in mild to moderate hypertension without hypokalaemia

Successful treatment of a mycotic aortic pseudoaneurysm in a patient with type 2 diabetes mellitus while treating primary aldosteronism with spironolactone

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