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Submitted on January 13, 2006
Accepted on April 21, 2006
Division of Internal Medicine and Hypertension, University of Torino, 10133 Torino, Italy; Division of Internal Medicine "3", University of Padova, 35128 Padova, Italy; Division of Internal Medicine, Reggio Emilia Hospital, 42100 Reggio Emilia, Italy; Division of Internal Medicine "B", University of Verona, 37134 Verona, Italy; Division of Endocrinology, P. Universitad Catolica de Chile, 114D Santiago, Chile; Division of Endocrinology and Metabolism, University of Torino, 10126 Torino, Italy
* To whom correspondence should be addressed. E-mail: paolo.mulatero{at}libero.it.
Context: Primary Aldosteronism (PA) is the most frequent form of secondary hypertension accounting for up to 5-10% of all hypertensive patients and the diagnosis of PA can present an important challenge for the clinician. After a positive screening test, the diagnosis is confirmed by a suppression test, often an i.v. saline load (SLT) or a fludrocortisone suppression test (FST). The FST is considered by many to be the most reliable but is more complex and expensive.
Objective and design: to compare the specificity of SLT with FST for the diagnosis of PA.
Setting: hypertensives referred to Hypertension Units.
Patients: 100 patients with suspected PA after the screening test.
Intervention: all patients underwent FST and SLT.
Main outcome measure: Plasma Aldosterone Concentrations (PAC) before and after FST and SLT.
Results: 10.4% PA patients were negative after i.v. SLT and 16.1% patients with essential hypertension (EH) were positive after SLT, that is, a correct diagnosis with SLT was obtained in 88% of patients compared with FST. PAC post-SLT and PAC post-FST were highly correlated (P < 0.0001). ROC curve analysis demonstrated that the best cut-off for PAC post-SLT was 5 ng/dL. Patients with aldosterone producing adenoma (APA) displayed a smaller reduction of PAC compared with patients with bilateral adrenal hyperplasia; a PAC post-SLT > 6 ng/dL identified all patients eventually diagnosed as having APA.
Conclusions: this study demonstrates that the i.v. SLT is a reasonably good alternative to the more expensive and complex FST for the diagnosis of PA after a positive screening test.
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