Predictors of confirmatory test results for the diagnosis of primary hyperaldosteronism in hypertensive patients with an aldosterone-to-renin ratio greater than 20. The SHRIMP study

Okamoto, Ryuji; Taniguchi, Masaya; Onishi, Yuki; Kumagai, Naoto; Uraki, Junji; Fujimoto, Naoki; Fujii, Eitaro; Yano, Yutaka; Ogura, Toru; M, Ito

doi:10.1038/s41440-018-0126-1

Cited by 14 publications

(25 citation statements)

References 32 publications

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“…Recently, ARR after CCT, PRA after FUT and PAC after SIT have been demonstrated as equally useful for discriminating APA from IHA. 18 In another recent report, PRA after FUT was significantly lower in APA than in IHA, 22 representing a difference from our report. Although we could not elucidate the precise reason for this discrepancy, they applied a 1 mg/kg dose of furosemide for the FUT, which is much more than the dose adopted in our study, which might have contributed to this difference.…”

Section: Discussioncontrasting

confidence: 93%

“…29 In addition, a recent report demonstrated that serum potassium concentration was useful for discriminating APA from IHA (optimal cut-off 3.45 mEq/l, sensitivity 62.5%, specificity 93.0%). 18 Similarly, some reports have described baseline ARR as useful for the diagnosis of APA.…”

Section: Discussionmentioning

confidence: 99%

“…Several recent reports have advocated the results of baseline laboratory data, confirmatory tests, 11 C-metomidate positron emission tomography (PET)-computed tomography, and 18-oxocortisol as reliable methods for discriminating between uni and bilateral PA, [16][17][18][19][20] and suggesting the possibility of substituting this process for AVS. Moreover, the rapid adrenocorticotropic hormone (ACTH) test has recently been proposed as useful for determining subtypes of PA. 21,22 However, few reports have examined the diagnostic significance of value changes in confirmatory testing for diagnosing the lateralisation of PA.…”

Section: Introductionmentioning

confidence: 99%

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Evaluation of various confirmatory tests for the diagnosis of aldosterone-producing adenoma

Kidoguchi

Sugano

Kawauchi

et al. 2020

J Renin Angiotensin Aldosterone Syst

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Introduction: Adrenal venous sampling is useful for discriminating unilateral and bilateral hypersecretion in patients with primary aldosteronism, but it is relatively invasive. To determine the site of hypersecretion more non-invasively, we evaluated predictors of unilateral hypersecretion. Materials and methods: We evaluated the baseline characteristics and the results of confirmatory tests of 123 patients with primary aldosteronism who underwent adrenal venous sampling. Results: Unilateral hypersecretion was identified in 22.0%. The plasma aldosterone concentration and aldosterone–renin ratio were significantly higher and serum potassium concentration and plasma renin activity were significantly lower in patients with unilateral hypersecretion. Plasma aldosterone concentrations after captopril challenge test, saline infusion test and rapid adrenocorticotropic hormone stimulation test were significantly higher among patients with unilateral hypersecretion. The plasma aldosterone concentration reduction ratio in saline infusion test and plasma aldosterone concentration elevation ratio during rapid adrenocorticotropic hormone stimulation test were significantly higher in patients with unilateral hypersecretion. However, areas under the curve for these parameters were not superior to the values after confirmatory tests. Conclusions: The plasma aldosterone concentration values after captopril challenge test, saline infusion test and rapid adrenocorticotropic hormone stimulation test were useful for identifying patients with unilateral hypersecretion. However, value changes or ratios during confirmatory tests are less useful for this aim.

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Section: Discussioncontrasting

confidence: 93%

Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

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Evaluation of various confirmatory tests for the diagnosis of aldosterone-producing adenoma

Kidoguchi

Sugano

Kawauchi

et al. 2020

J Renin Angiotensin Aldosterone Syst

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“…28 As a matter of fact, ARR after the CCT was also reported to be helpful for differentiation of APA from EH and idiopathic hyperaldosteronism (IHA) at the threshold of ARR=422 (sensitivity 75.0%, specificity 81.0%). 29…”

Section: Discussionmentioning

confidence: 99%

The characteristics of captopril challenge test–positive patients using various criteria

Kidoguchi

Sugano

Hayashi-Ishikawa

et al. 2019

J Renin Angiotensin Aldosterone Syst

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Introduction: The captopril challenge test (CCT) is the major confirmatory test for primary aldosteronism (PA), and frequently carried out because of its convenience. However, it presents false-negative results with a certain probability, and as there are many criteria for CCT, it is not concluded yet which criteria to use. Materials and methods: A total of 71 PA patients were evaluated. We compared CCT-positive and CCT-negative patients in the following three criteria: plasma aldosterone/renin ratio (ARR) >200 after the CCT (criterion 1); plasma aldosterone concentration (PAC) >120 pg/ml after the CCT (criterion 2); and PAC suppression <30% of PAC before CCT (criterion 3). Results: The positive rate was 70.4%, 64.8% and 54.9% for criterion 1, criterion 2 and criterion 3, respectively. With criterion 1, the baseline plasma renin activity was lower, thus baseline ARR was higher in CCT-positive patients. With criterion 2, PAC was higher and estimated sodium intake and K were lower in CCT-positive patients. With criterion 3, K and PAC were lower in CCT-positive patients. Although it was not significant, in the patients with high sodium intake, the positive rate of criterion 1 was higher than that of the other criteria. Conclusions: ARR>200 is the valuable criterion for the diagnosis of PA.

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“…Primary aldosteronism (PA) is the most common cause of endocrine hypertension, which significantly increases cardiovascular complications due to autonomous aldosterone production [ 1 ]. PA is diagnosed by confirmatory tests [ 2 ] and is primarily classified as unilateral PA, chiefly aldosterone-producing adenoma (APA, generally unilateral), or bilateral PA (also called idiopathic hyperaldosteronism) [ 3 ]. The former is often curable by unilateral adrenalectomy, whereas the latter is mostly treated by lifelong mineralocorticoid receptor antagonists [ 4 ].…”

Section: Introductionmentioning

confidence: 99%

Diverse pathological lesions of primary aldosteronism and their clinical significance

Nishimoto

Umakoshi

Seki³

et al. 2021

Hypertens Res

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Primary aldosteronism (PA) is mainly clinically classified as unilateral aldosterone-producing adenoma (APA) or bilateral idiopathic hyperaldosteronism. Immunohistochemistry for aldosterone synthase reveals a diverse PA pathology, including pathological APA and aldosterone-producing cell clusters. The relationship between PA pathology and adrenalectomy outcomes was examined herein. Data from 219 unilaterally adrenalectomized PA cases were analyzed. Pathological analyses revealed diverse putative aldosterone-producing lesions. Postoperative biochemical outcomes in 114 cases (test cohort) were classified as complete success (n = 85), partial success (n = 19), and absent success (n = 10). Outcomes in the large and small PA lesion groups, rather than between PA lesion types, were compared at five threshold values for PA lesion sizes (2–6 mm with 1-mm increments) to streamline the results. The proportion of complete success was significantly higher in the large PA lesion group than in the small PA lesion group at the 5-mm threshold only. The proportion of absent success was significantly higher in the small PA lesion group than in the large PA lesion group at all thresholds. Univariate and multivariate analyses of the test cohort identified serum K as an independent predictive factor for the small PA lesion group, which was confirmed in the 105-case validation cohort. Chi-squared automatic interaction detector analysis revealed that the best threshold of serum K for predicting large PA lesions was 2.82 mEq/L. These results will be beneficial for treating PA in clinical settings because patients with low serum K levels and apparent adrenal masses on CT may be subjected to adrenalectomy even if the adrenal venous sampling test is unavailable.

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Predictors of confirmatory test results for the diagnosis of primary hyperaldosteronism in hypertensive patients with an aldosterone-to-renin ratio greater than 20. The SHRIMP study

Cited by 14 publications

References 32 publications

Evaluation of various confirmatory tests for the diagnosis of aldosterone-producing adenoma

Evaluation of various confirmatory tests for the diagnosis of aldosterone-producing adenoma

The characteristics of captopril challenge test–positive patients using various criteria

Diverse pathological lesions of primary aldosteronism and their clinical significance

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