Comparison of Seated With Recumbent Saline Suppression Testing for the Diagnosis of Primary Aldosteronism

Stowasser, Michael; Ahmed, Ashraf; Cowley, Diane; Wolley, Martin; Guo, Zeng; McWhinney, Brett; Ungerer, Jacobus P.J.; Gordon, Richard D.

doi:10.1210/jc.2018-01394

Cited by 71 publications

(49 citation statements)

References 23 publications

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“…However, when PAC of 10.0 ng/dL, which was indicated by the guideline as a confirmation of PA, was adopted, 6 Our results have shown that post-SSIT PACs in unilateral PA were higher than those in bilateral PA in agreement with the previous study. 9 However, the median post-SSIT PACs were relatively higher in this study than those in the previous study in unilateral (21.0 vs. 11.1 ng/dL) and bilateral PA (9.2 vs. 7.0 ng/dL). This could be attributed to differences in patient selection, diagnostic criteria for subtypes and assay to measure PACs (radioimmunoassay vs. highperformance liquid chromatography-tandem mass spectrometry).…”

Section: Discussioncontrasting

confidence: 82%

“…6 In the previous study, the optimal PAC cut-off for SSIT to confirm the diagnosis of PA was 5.8 ng/dL. 9 We examined the efficacy of SSIT in subtype diagnosis of PA with these cut-offs. Table 3 shows the results of SSIT using these cut-offs.…”

Section: Roc Analysis Of Ssit and Dex-atmentioning

confidence: 99%

“…8 A previous study 9 showed that seated saline infusion test (SSIT) was highly sensitive and superior to recumbent SIT in identifying both unilateral and bilateral forms of PA. 8 A previous study 9 showed that seated saline infusion test (SSIT) was highly sensitive and superior to recumbent SIT in identifying both unilateral and bilateral forms of PA.…”

Section: Introductionmentioning

confidence: 99%

“…The SIT is widely used as a confirmatory test of PA because it is safe and requires a short time at the outpatient clinic. 8 A previous study 9 showed that seated saline infusion test (SSIT) was highly sensitive and superior to recumbent SIT in identifying both unilateral and bilateral forms of PA. Since recumbent SIT has the possibility of missing patients with PA in whom aldosterone production was responsive to the upright position, SSIT might be a reliable alternative to recumbent SIT.…”

Section: Introductionmentioning

confidence: 99%

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Seated saline infusion test in predicting subtype diagnosis of primary aldosteronism

Kaneko

Umakoshi

Ishihara

et al. 2019

Clinical Endocrinology

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Context:Although saline infusion test is widely used as a confirmatory test for primary aldosteronism (PA), it is reportedly less sensitive in patients in whom aldosterone is responsive to the upright position by performing it in recumbent position.Based on a single-centre experience, seated saline infusion test (SSIT) has been reported to be highly sensitive and superior to recumbent testing in identifying both unilateral and bilateral forms of PA. However, due to limited participants number, the utility of SSIT needs to be validated in other series.Objective: This study aimed to evaluate the accuracy of SSIT in determining the PA subtypes compared with adrenocorticotropic hormone stimulation test under dexamethasone suppression (Dex-AT). Patients and Setting: Sixty-four patients with PA who underwent both SSIT and Dex-AT were included. Subtype diagnosis of PA was determined by adrenal venous sampling (AVS) (16 unilateral and 48 bilateral forms). Main Outcome Measure: Plasma aldosterone concentrations (PACs) were measured after SSIT and Dex-AT. Results:The area under the receiver operating characteristic (ROC) curve for diagnosing unilateral PA was greater in SSIT than that in Dex-AT (0.907 vs. 0.755; P = .023).ROC curve analysis predicted optimal cut-off PACs of 13.1 ng/dL (sensitivity, 93.8%; specificity, 79.2%) for SSIT and 34.2 ng/dL (sensitivity, 75.0%; specificity, 68.8%) for Dex-AT.Conclusions: Seated saline infusion test has superior accuracy in subtype diagnosis of PA compared with Dex-AT. SSIT can be a sensitive test for determining patients who require AVS prior to surgery. K E Y W O R D Sadrenal cortex function tests, adrenocortical adenoma, aldosterone, cosyntropin, hyperaldosteronism, hypertension, renin-angiotensin system

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Section: Discussioncontrasting

confidence: 82%

Section: Roc Analysis Of Ssit and Dex-atmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

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Seated saline infusion test in predicting subtype diagnosis of primary aldosteronism

Kaneko

Umakoshi

Ishihara

et al. 2019

Clinical Endocrinology

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“…The first is the emerging consensus that a patient who has clearly florid primary aldosteronism on the basis of their ARR might be spared confirmatory/exclusion testing and proceed directly to imaging. The second is the recent development of the seated saline suppression confirmatory test [24,25], results of which align very closely with the four day sodium and fludrocortisone suppression test, clearly the most laborious and on occasion termed 'the gold standard'.…”

Section: Diagnosis: Towards Uniformity In Confirmatory Testingmentioning

confidence: 80%

Primary Aldosteronism: Where Are We Now? Where to from Here?

Funder

2020

Horm Metab Res

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The past nine years have seen major advances in establishing the etiology of unilateral primary aldosteronism, and very possibly that of bilateral hyperaldosteronism, in response to somatic mutations in aldosterone synthase expressing cells. Though there have been important advances in the management of primary aldosteronism, in small but convincing studies, they represent minor changes to current guidelines. What has been totally absent is consideration of the public health issue that primary aldosterone represents, and the public policy issues that would be involved in addressing the disorder. In his introduction to PiPA 6, Martin Reincke calculated that only one in a thousand patients in Germany with primary aldosteronism were treated appropriately, an astounding figure for any disease in the 21st century. Towards remedying this totally unacceptable public health issue, the author proposes a radical simplification and streamlining of screening for primary aldosteronism, and the management of most patients by general practitioners. The second bottle-neck in current management is that of mandatory adrenal venous sampling for all but 1–2% of patients, a costly procedure requiring rare expertise. Ideally, it should be reserved – on the basis of likelihood, enhanced imaging, or peripheral steroid profiles – for a small minority of patients with clear evidence for unilateral disease. Only when costs are minimized and roadblocks removed will primary aldosteronism be properly treated as the public health issue that it is.

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Testing for Secondary Hypertension and Difficult to Control Patients

Azzam,

Kiuchi,

Carnagarin

et al. 2023

Renal Denervation

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Comparison of Seated With Recumbent Saline Suppression Testing for the Diagnosis of Primary Aldosteronism

Abstract: SSST is highly sensitive and superior to RSST in identifying both unilateral and bilateral forms of PA and has a low rate of false positives and inconclusive results. It therefore offers a reliable and much less complicated and expensive alternative to FST for confirming PA.

Cited by 71 publications

References 23 publications

Seated saline infusion test in predicting subtype diagnosis of primary aldosteronism

Seated saline infusion test in predicting subtype diagnosis of primary aldosteronism

Primary Aldosteronism: Where Are We Now? Where to from Here?

Testing for Secondary Hypertension and Difficult to Control Patients

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