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Cut-off value to diagnose primary aldosteronism may be higher than previously recommended
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In identifying primary aldosteronism in Chinese patients, the optimal post-saline infusion test cut-off value was 11.45 ng/dL, according to recent study findings published in The Journal of Clinical Metabolism and Endocrinology.
These values are higher than those currently recommended by clinical practice guidelines from the Endocrine Society, according to researchers.
Yerong Yu, MD, of the department of endocrinology and metabolism at West China Hospital, and colleagues evaluated 120 adults with hypertension who conformed to the primary aldosteronism screening criteria and 21 healthy controls to determine the serum aldosterone response after a saline infusion test in people with primary aldosteronism, essential hypertension and healthy controls. Researchers further sought to determine the optimal aldosterone levels of post-saline infusion test to diagnose primary aldosteronism.
All participants had plasma aldosterone concentration measures before and after saline infusion test. Two timed 24-hour urinary excretion measures were used to estimate total sodium intake.
Compared with the hypertension and control groups, plasma aldosterone concentration was higher in the primary aldosteronism group (P < .01). Although increased blood pressure was seen with saline infusion test, no adverse effects occurred.
Post-saline infusion test plasma aldosterone concentration was higher in the primary aldosteronism group compared with the essential hypertension and control groups (P < .01).
Plasma aldosterone concentration post-saline infusion test was higher than 10 ng/dL in the primary aldosterone group and higher than 5 ng/dL, except for one with a concentration of 4.93 ng/dL, in the hypertension and control groups. There was an 88.2% sensitivity and 95.4% specificity for a plasma aldosterone concentration of 11.45 ng/dL after saline infusion test, revealing an optimal cut-off value for primary aldosterone diagnosis.
“In summary, this study indicates that it is appropriate for Chinese patients to use a baseline [plasma aldosterone concentration] of 15 ng/dL as a cut-off in the screening test,” the researchers wrote. “[Saline infusion test] is a reliable functional test to confirm the diagnosis of [primary aldosteronism] in patients with a positive case detection but the optimal post-[saline infusion test] aldosterone cut-off values for identifying [primary aldosteronism] was 11.45 ng/dL in Chinese patients, which was higher than the recommendations of the current clinical practice guidelines of the Endocrine Society.” – by Amber Cox
Disclosure: The researchers report no relevant financial disclosures.
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