Saline suppression test parameters may predict bilateral subtypes of primary aldosteronism

Hikaru Hashimura, Jimmy Shen, Peter J. Fuller, Nicholas Y.N. Chee, James C.G. Doery, Winston Chong, Kay Weng Choy, Stella May Gwini, Jun Yang

Research output: Contribution to journalArticleResearchpeer-review

Abstract

Background: The saline suppression test (SST) serves to confirm the diagnosis of primary aldosteronism (PA) whilst adrenal vein sampling (AVS) is used to determine whether the aldosterone hypersecretion is unilateral or bilateral. An accurate prediction of bilateral PA based on SST results could reduce the need for AVS. Aim: We sought to identify SST parameters that reliably predict bilateral PA. Methods: The results from 121 patients undergoing SSTs at Monash Health from January 2010 to January 2018 including screening blood tests, imaging, AVS and histopathology results were evaluated. Patients were subtyped into unilateral or bilateral PA based on AVS and surgical outcomes. Results: Of 113 patients with confirmed PA, 33 had unilateral disease whilst 42 had bilateral disease. In those with bilateral disease, plasma aldosterone concentration (PAC) was significantly lower post-SST, together with a significant fall in the aldosterone-renin ratio (ARR). The combination of PAC < 300 pmol/L and a reduction in ARR post-SST provided 96.8% specificity in predicting bilateral disease. Eighteen of 39 patients (49%) with bilateral PA could have avoided AVS using these criteria. Conclusion: A combination of PAC < 300 pmol/L and a lower ARR post-SST could reliably predict bilateral PA. An independent cohort will be needed to validate these findings.

Original languageEnglish
Pages (from-to)308-313
Number of pages6
JournalClinical Endocrinology
Volume89
Issue number3
DOIs
Publication statusPublished - 1 Sep 2018

Keywords

  • adrenal adenoma
  • adrenal hyperplasia
  • aldosterone-renin ratio
  • primary aldosteronism
  • saline suppression test

Cite this

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title = "Saline suppression test parameters may predict bilateral subtypes of primary aldosteronism",
abstract = "Background: The saline suppression test (SST) serves to confirm the diagnosis of primary aldosteronism (PA) whilst adrenal vein sampling (AVS) is used to determine whether the aldosterone hypersecretion is unilateral or bilateral. An accurate prediction of bilateral PA based on SST results could reduce the need for AVS. Aim: We sought to identify SST parameters that reliably predict bilateral PA. Methods: The results from 121 patients undergoing SSTs at Monash Health from January 2010 to January 2018 including screening blood tests, imaging, AVS and histopathology results were evaluated. Patients were subtyped into unilateral or bilateral PA based on AVS and surgical outcomes. Results: Of 113 patients with confirmed PA, 33 had unilateral disease whilst 42 had bilateral disease. In those with bilateral disease, plasma aldosterone concentration (PAC) was significantly lower post-SST, together with a significant fall in the aldosterone-renin ratio (ARR). The combination of PAC < 300 pmol/L and a reduction in ARR post-SST provided 96.8{\%} specificity in predicting bilateral disease. Eighteen of 39 patients (49{\%}) with bilateral PA could have avoided AVS using these criteria. Conclusion: A combination of PAC < 300 pmol/L and a lower ARR post-SST could reliably predict bilateral PA. An independent cohort will be needed to validate these findings.",
keywords = "adrenal adenoma, adrenal hyperplasia, aldosterone-renin ratio, primary aldosteronism, saline suppression test",
author = "Hikaru Hashimura and Jimmy Shen and Fuller, {Peter J.} and Chee, {Nicholas Y.N.} and Doery, {James C.G.} and Winston Chong and Choy, {Kay Weng} and Gwini, {Stella May} and Jun Yang",
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Saline suppression test parameters may predict bilateral subtypes of primary aldosteronism. / Hashimura, Hikaru; Shen, Jimmy; Fuller, Peter J.; Chee, Nicholas Y.N.; Doery, James C.G.; Chong, Winston; Choy, Kay Weng; Gwini, Stella May; Yang, Jun.

In: Clinical Endocrinology, Vol. 89, No. 3, 01.09.2018, p. 308-313.

Research output: Contribution to journalArticleResearchpeer-review

TY - JOUR

T1 - Saline suppression test parameters may predict bilateral subtypes of primary aldosteronism

AU - Hashimura, Hikaru

AU - Shen, Jimmy

AU - Fuller, Peter J.

AU - Chee, Nicholas Y.N.

AU - Doery, James C.G.

AU - Chong, Winston

AU - Choy, Kay Weng

AU - Gwini, Stella May

AU - Yang, Jun

PY - 2018/9/1

Y1 - 2018/9/1

N2 - Background: The saline suppression test (SST) serves to confirm the diagnosis of primary aldosteronism (PA) whilst adrenal vein sampling (AVS) is used to determine whether the aldosterone hypersecretion is unilateral or bilateral. An accurate prediction of bilateral PA based on SST results could reduce the need for AVS. Aim: We sought to identify SST parameters that reliably predict bilateral PA. Methods: The results from 121 patients undergoing SSTs at Monash Health from January 2010 to January 2018 including screening blood tests, imaging, AVS and histopathology results were evaluated. Patients were subtyped into unilateral or bilateral PA based on AVS and surgical outcomes. Results: Of 113 patients with confirmed PA, 33 had unilateral disease whilst 42 had bilateral disease. In those with bilateral disease, plasma aldosterone concentration (PAC) was significantly lower post-SST, together with a significant fall in the aldosterone-renin ratio (ARR). The combination of PAC < 300 pmol/L and a reduction in ARR post-SST provided 96.8% specificity in predicting bilateral disease. Eighteen of 39 patients (49%) with bilateral PA could have avoided AVS using these criteria. Conclusion: A combination of PAC < 300 pmol/L and a lower ARR post-SST could reliably predict bilateral PA. An independent cohort will be needed to validate these findings.

AB - Background: The saline suppression test (SST) serves to confirm the diagnosis of primary aldosteronism (PA) whilst adrenal vein sampling (AVS) is used to determine whether the aldosterone hypersecretion is unilateral or bilateral. An accurate prediction of bilateral PA based on SST results could reduce the need for AVS. Aim: We sought to identify SST parameters that reliably predict bilateral PA. Methods: The results from 121 patients undergoing SSTs at Monash Health from January 2010 to January 2018 including screening blood tests, imaging, AVS and histopathology results were evaluated. Patients were subtyped into unilateral or bilateral PA based on AVS and surgical outcomes. Results: Of 113 patients with confirmed PA, 33 had unilateral disease whilst 42 had bilateral disease. In those with bilateral disease, plasma aldosterone concentration (PAC) was significantly lower post-SST, together with a significant fall in the aldosterone-renin ratio (ARR). The combination of PAC < 300 pmol/L and a reduction in ARR post-SST provided 96.8% specificity in predicting bilateral disease. Eighteen of 39 patients (49%) with bilateral PA could have avoided AVS using these criteria. Conclusion: A combination of PAC < 300 pmol/L and a lower ARR post-SST could reliably predict bilateral PA. An independent cohort will be needed to validate these findings.

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JF - Clinical Endocrinology

SN - 0300-0664

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ER -