Evaluation of Patients Performed with Saline Infusion Test with a Pre-Diagnosis of Primary Hyperaldosteronism

Year 2022, Volume: 4 - Supplement 1, 29 - 33, 01.04.2022

Coşkun Ateş , Gül Ada , Filiz Mercan Sarıdaş , Ensar Aydemir , Erhan Hocaoğlu , Özen Öz Gül , Soner Cander , Canan Ersoy , Erdinç Ertürk

https://doi.org/10.46310/tjim.1072050

Abstract

Background: Primary hyperaldosteronism (PHA) is a primarily treatable cause of arterial hypertension characterized by low plasma renin and high aldosterone levels. The prevalence of secondary hypertension as a common endocrine cause is 5-13%. The plasma aldosterone/renin ratio (ARR) is the best available method for PHA screening. One or more confirmatory tests may be required to confirm or exclude patients' diagnoses. One frequently used confirmatory test is the saline infusion test (SİT). We aimed to screen the patients who underwent SİT with the preliminary diagnosis of PHA and to compare the results of the patients diagnosed with essential hypertension (EH) and PHA.
Material and Methods: Seventy-seven patients with a history of drug-resistant hypertension or unexplained spontaneous or diuretic-induced hypokalemia or adrenal incidentaloma, or a family history of early-onset hypertension or cerebrovascular accident at a young age (<40 years) and undergoing saline infusion testing were included in the study.
Results: Twenty-six (33.8%) of the patients were male and 51 (66.2%) were female. The mean age of the patients was 54.5±13.7 years. EH was present in 39 (50.6%) patients, and PHA was present in 38 (49.4%) patients. Patients with PHA and EH were compared. There was no significant difference between mean systolic blood pressure, diastolic blood pressure, potassium, and aldosterone renin ratio (ARR) in the two groups (p>0.05). Basal plasma aldosterone (p<0.05), SİT 0th, and 4th-hour plasma aldosterone levels (p<0.01) was significantly higher in PHA than in EH. Aldosterone synthesizing adenoma (ASA) and idiopathic hyperaldosteronism (IHA) were compared. There were no significant differences between basal plasma aldosterone, SİT 0th, and 4th-hour plasma aldosterone levels, ARR, and potassium values (p>0.05). The mean sodium value was significantly higher than the IHA (p <0.05).
Conclusion: Our study determined that the saline infusion test could be used to confirm the diagnosis of primary hyperaldosteronism. Its use alone was not sufficient in the differential diagnosis of aldosterone-synthesizing adenoma and idiopathic hyperaldosteronism.

Keywords

primary hyperaldosteronism, saline infusion test, essential hypertension, secondary hypertension, endocrine hypertension

References

• Rossi GP. Primary aldosteronism: JACC State-of-the-Art Review. J Am Coll Cardiol. 2019 Dec 3;74(22):2799-811. doi: 10. 1016/j.jacc.2019.09.057.
• Rossi GP, Bernini G, Caliumi C, Desideri G, Fabris B, Ferri C, Ganzaroli C, Giacchetti G, Letizia C, Maccario M, Mallamaci F, Mannelli M, Mattarello MJ, Moretti A, Palumbo G, Parenti G, Porteri E, Semplicini A, Rizzoni D, Rossi E, Boscaro M, Pessina AC, Mantero F; PAPY Study Investigators. A prospective study of the prevalence of primary aldosteronism in 1,125 hypertensive patients. J Am Coll Cardiol. 2006 Dec 5;48(11):2293-300. doi: 10.1016/j.jacc.2006.07.059.
• Conn JW. Aldosterone in clinical medicine; past, present, and future. AMA Arch Intern Med. 1956 Feb;97(2):135-44. doi: 10.1001/archinte.1956.00250200011001.
• Catena C, Colussi G, Sechi LA. Treatment of primary aldosteronism and organ protection. Int J Endocrinol. 2015;2015:597247. doi: 10.1155/2015/597247.
• Reincke M, Fischer E, Gerum S, Merkle K, Schulz S, Pallauf A, Quinkler M, HanslikG , Lang K, Hahner S, Allolio B, Meisinger C, Holle R, Beuschlein F, Bidlingmaier M, Endres S. Observational study mortality in treated primary aldosteronism: the German Conn’s registry. Hypertension. 2012 Sep;60(3):618- 24. doi: 10.1161/HYPERTENSIONAHA.112.197111.
• Funder JW, Carey RM, Mantero F, Murad MH, Reincke M, Shibata H, Stowasser M, Young WF. The management of primary aldosteronism: case detection, diagnosis, and treatment: an Endocrine Society clinical practice guideline. J Clin Endocrinol Metab. 2016 May;101(5):1889-916. doi: 10.1210/ jc.2015-4061.
• Funder JW, Carey RM, Fardella C, Gomez-Sanchez CE, Mantero F, Stowasser M, Young Jr WF, V Montori VM. Case detection, diagnosis, and treatment of patients with primary aldosteronism: an endocrine society clinical practice guideline. J Clin Endocrinol Metab. 2008 Sep;93(9):3266-81. doi: 10.1210/ jc.2008-0104.
• Giacchetti G, Ronconi V, Lucarelli G, Boscaro M, Mantero F. Analysis of screening and confirmatory tests in the diagnosis of primary aldosteronism: need for a standardized protocol. J Hypertens. 2006 Apr;24(4):737-45. doi: 10.1097/01. hjh.0000217857.20241.0f.
• Rossi GP, Belfiore A, Bernini G, Desideri G, Fabris B, Ferri C, Giacchetti G, Letizia C, Maccario M, Mallamaci F, Mannelli M, Montemurro D, Palumbo G, Rizzoni D, Rossi E, Semplicini A, Agabiti-Rosei E, Pessina AC, Mantero F; PAPY Study Investigators. Prospective evaluation of the saline infusion test for excluding primary aldosteronism due to aldosterone- producing adenoma. J Hypertens. 2007 Jul;25(7):1433-42. doi: 10.1097/HJH.0b013e328126856e.
• Ahmed AH, Gordon RD, Taylor PJ, Ward G, Pimenta E, Stowasser M. Are women more at risk of false-positive primary aldosteronism screening and unnecessary suppression testing than men? J Clin Endocrinol Metab. 2011 Feb;96(2):E340-6. doi: 10.1210/jc.2010-1355.
• Rossi GP. A comprehensive review of the clinical aspects of primary aldosteronism. Nat Rev Endocrinol. 2011 May 24;7(8):485-95. doi: 10.1038/nrendo.2011.76.
• Alam S, Kandasamy D, Goyal A, Vishnubhatla S, Singh S, Karthikeyan G, Khadgawat R. High prevalence and a long delay in the diagnosis of primary aldosteronism among patients with young-onset hypertension. Clin Endocrinol (Oxf). 2021 Jun;94(6):895-903. doi: 10.1111/cen.14409.
• Mulatero P, Stowasser M, Loh KC, Fardella CE, Gordon RD, Mosso L, Gomez-Sanchez CE, Veglio F, Young WF Jr. Increased diagnosis of primary aldosteronism, including surgically correctableforms,incentersfromfivecontinents.JClinEndocrinol Metab. 2004 Mar;89(3):1045-50. doi: 10.1210/jc.2003-031337.