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Post-saline infusion test aldosterone levels indicate severity and outcome in primary aldosteronism.

Clinical EndocrinologyCharité Campus Mitte, Charité University Medicine Berlin, Berlin, GermanyMedizinische Klinik und Poliklinik IVUniversity Hospital Munich, Munich, GermanyDepartment of Internal Medicine IUniversity Hospital Würzburg, Würzburg, GermanyDivision for Specific EndocrinologyMedical Faculty, University Duesseldorf, Duesseldorf, GermanyDivision of Endocrinology and MetabolismRostock University Medical Center, Rostock, GermanyEndocrinology in CharlottenburgStuttgarter Platz 1, D10627 Berlin, Germany. Clinical EndocrinologyCharité Campus Mitte, Charité University Medicine Berlin, Berlin, GermanyMedizinische Klinik und Poliklinik IVUniversity Hospital Munich, Munich, GermanyDepartment of Internal Medicine IUniversity Hospital Würzburg, Würzburg, GermanyDivision for Specific EndocrinologyMedical Faculty, University Duesseldorf, Duesseldorf, GermanyDivision of Endocrinology and MetabolismRostock University Medical Center, Rostock, GermanyEndocrinology in CharlottenburgStuttgarter Platz 1, D10627 Berlin, Germany Clinical EndocrinologyCharité Campus Mitte, Charité University Medicine Berlin, Berlin, GermanyMedizinische Klinik und Poliklinik IVUniversity Hospital Munich, Munich, GermanyDepartment of Internal Medicine IUniversity Hospital Würzburg, Würzburg, GermanyDivision for Specific EndocrinologyMedical Faculty, University Duesseldorf, Duesseldorf, GermanyDivision of Endocrinology and MetabolismRostock University Medical Center, Rostock, GermanyEndocrinology in CharlottenburgStuttgarter Platz 1, D10627 Berlin, Germany. Clinical EndocrinologyCharité Campus Mitte, Charité University Medicine Berlin, Berlin, GermanyMedizinische Klinik und Poliklinik IVUniversity Hospital Munich, Munich, GermanyDepartment of Internal Medicine IUniversity Hospital Würzburg, Würzburg, GermanyDivision for Specific EndocrinologyMedical Faculty, University Duesseldorf, Duesseldorf, GermanyDivision of Endocrinology and MetabolismRostock University Medical Center, Rostock, GermanyEndocrinology in CharlottenburgStuttgarter Platz 1, D10627 Berlin, Germany Clinical EndocrinologyCharité Campus Mitte, Charité University Medicine Berlin, Berlin, GermanyMedizinische Klinik und Poliklinik IVUniversity Hospital Munich, Munich, GermanyDepartment of Internal Medicine IUniversity Hospital Würzburg, Würzburg, GermanyDivision for Specific EndocrinologyMedical Faculty, University Duesseldorf, Duesseldorf, GermanyDivision of Endocrinology and MetabolismRostock University Medical Center, Rostock, GermanyEndocrinology in CharlottenburgStuttgarter Platz 1, D10627 Berlin, Germany marcusquinkler@t-online.de.

European journal of endocrinology. 2015;(4):443-50
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Abstract

OBJECTIVE The saline infusion test (SIT) is widely used as a confirmatory test for primary aldosteronism (PA). SIT results are judged as follows: post-test aldosterone levels <50 ng/l exclude PA, whereas levels >50 ng/l confirm PA. We hypothesized that post-SIT aldosterone concentrations indicate the severity of PA and might predict outcome. DESIGN The study includes 256 PA patients of the German Conn's Registry who prospectively underwent SIT. The data of 126 patients with complete follow-up of 1.2±0.3 years after diagnosis were analyzed. The patients were divided into two groups with post-SIT aldosterone levels of 50-100 ng/l (group 1; n=38) and of >100 ng/l (group 2; n=88). RESULTS Patients in group 2 had a significantly shorter duration of hypertension (7.5 vs 11.7 years (median), P=0.014), higher systolic blood pressure (BP; 151±16 vs 143±17 mmHg, P=0.036), lower serum potassium (3.3±0.6 vs 3.5±0.4 mmol/l, P=0.006), higher 24-h urine protein excretion (7.4 vs 5.4 mg/dl (median), P=0.012), and were more often female (P=0.038). They showed more often unilateral disease (P<0.005) with larger tumors (14±10 vs 7±10 mm, P=0.021), underwent more often adrenalectomy (75% vs 37%, P<0.005), required a lower number of antihypertensive drugs after adrenalectomy (1.2±1.2 vs 2.5±1.4, P=0.001), had a faster normalization of urinary protein excretion (with medical treatment P=0.049; with Adx P<0.005) at follow-up, and more frequently underlying well-characterized mutation (P=0.047). CONCLUSIONS PA patients with post-SIT aldosterone levels of >100 ng/l have a more rapid development of PA caused more frequently by unilateral disease with larger aldosterone-producing adenomas. However, this group of patients may have a significantly better outcome following specific treatment.

Methodological quality

Publication Type : Clinical Trial ; Multicenter Study

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MeSH terms : Aldosterone