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Seated Saline Suppression Testing For The Diagnosis Of Primary Aldosteronism: A Preliminary Study

Context: Failure of aldosterone suppression by sodium loading during fludrocortisone suppression testing (FST) or saline suppression testing (SST) confirms primary aldosteronism (PA). We previously found recumbent SST (RSST) to lack sensitivity. Aldosterone levels can be higher upright (e.g. seated)... Full description

Journal Title: The journal of clinical endocrinology and metabolism 2014, Vol.99 (8), p.2745-2753
Main Author: Ahmed, Ashraf H
Other Authors: Cowley, Diane , Wolley, Martin , Gordon, Richard D , Xu, Shengxin , Taylor, Paul J , Stowasser, Michael
Format: Electronic Article Electronic Article
Language: English
Subjects:
Publisher: Bethesda, MD: Endocrine Society
ID: ISSN: 0021-972X
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recordid: cdi_proquest_miscellaneous_1552367683
title: Seated Saline Suppression Testing For The Diagnosis Of Primary Aldosteronism: A Preliminary Study
format: Article
creator:
  • Ahmed, Ashraf H
  • Cowley, Diane
  • Wolley, Martin
  • Gordon, Richard D
  • Xu, Shengxin
  • Taylor, Paul J
  • Stowasser, Michael
subjects:
  • Adrenal Cortex Function Tests - methods
  • Adrenals. Adrenal axis. Renin-angiotensin system (diseases)
  • Adult
  • Aged
  • Aldosterone - blood
  • Biological and medical sciences
  • Endocrinopathies
  • Feeding. Feeding behavior
  • Female
  • Fludrocortisone - administration & dosage
  • Fundamental and applied biological sciences. Psychology
  • Humans
  • Hyperaldosteronism - blood
  • Hyperaldosteronism - diagnosis
  • Male
  • Medical sciences
  • Middle Aged
  • Non tumoral diseases. Target tissue resistance. Benign neoplasms
  • Pilot Projects
  • Posture - physiology
  • Renin - blood
  • Sodium Chloride
  • Vertebrates: anatomy and physiology, studies on body, several organs or systems
  • Vertebrates: endocrinology
ispartof: The journal of clinical endocrinology and metabolism, 2014, Vol.99 (8), p.2745-2753
description: Context: Failure of aldosterone suppression by sodium loading during fludrocortisone suppression testing (FST) or saline suppression testing (SST) confirms primary aldosteronism (PA). We previously found recumbent SST (RSST) to lack sensitivity. Aldosterone levels can be higher upright (e.g. seated) than recumbent in patients with PA and upright levels are used during FST. We therefore hypothesized that seated SST (SSST) is more sensitive than RSST, especially for posture-responsive PA. Setting and Design: Of 66 patients who underwent FST (upright plasma aldosterone levels measured at 10am basally and after 4 days fludrocortisone 0.1 mg 6-hourly and oral salt loading), 31 underwent SST (aldosterone levels measured basally at 8am and after infusion of 2 L normal saline over 4h) both recumbent and seated in randomized order and at least 2 weeks apart. Results: FST confirmed PA in 23 of 31 patients (day 4 upright aldosterone level >165 pmol/L), excluded PA in three and was originally “inconclusive” in five. However, one with “inconclusive” FST had PA confirmed by lateralizing AVS and was reclassified “unilateral PA”. Of 24 with confirmed PA (eight unilateral, 11 bilateral, and five undetermined subtype), 23 (96%) tested positive by SSST (4-h aldosterone level >165 pmol/L) compared with 8 (33%) by RSST (4-h plasma aldosterone level >140 pmol/L) (P < .001). RSST missed one unilateral, all bilateral, and four with as-yet undetermined subtype. RSST was positive in 7 of 10 (70%) posture-unresponsive vs one of 14 (7.1%) posture-responsive patients (P < .005). Conclusion: These preliminary results suggest that seated SST may be superior to recumbent SST in terms of sensitivity for detecting PA, especially posture-responsive forms, and may represent a reliable alternative to FST.
language: eng
source:
identifier: ISSN: 0021-972X
fulltext: no_fulltext
issn:
  • 0021-972X
  • 1945-7197
url: Link


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titleSeated Saline Suppression Testing For The Diagnosis Of Primary Aldosteronism: A Preliminary Study
creatorAhmed, Ashraf H ; Cowley, Diane ; Wolley, Martin ; Gordon, Richard D ; Xu, Shengxin ; Taylor, Paul J ; Stowasser, Michael
creatorcontribAhmed, Ashraf H ; Cowley, Diane ; Wolley, Martin ; Gordon, Richard D ; Xu, Shengxin ; Taylor, Paul J ; Stowasser, Michael
descriptionContext: Failure of aldosterone suppression by sodium loading during fludrocortisone suppression testing (FST) or saline suppression testing (SST) confirms primary aldosteronism (PA). We previously found recumbent SST (RSST) to lack sensitivity. Aldosterone levels can be higher upright (e.g. seated) than recumbent in patients with PA and upright levels are used during FST. We therefore hypothesized that seated SST (SSST) is more sensitive than RSST, especially for posture-responsive PA. Setting and Design: Of 66 patients who underwent FST (upright plasma aldosterone levels measured at 10am basally and after 4 days fludrocortisone 0.1 mg 6-hourly and oral salt loading), 31 underwent SST (aldosterone levels measured basally at 8am and after infusion of 2 L normal saline over 4h) both recumbent and seated in randomized order and at least 2 weeks apart. Results: FST confirmed PA in 23 of 31 patients (day 4 upright aldosterone level >165 pmol/L), excluded PA in three and was originally “inconclusive” in five. However, one with “inconclusive” FST had PA confirmed by lateralizing AVS and was reclassified “unilateral PA”. Of 24 with confirmed PA (eight unilateral, 11 bilateral, and five undetermined subtype), 23 (96%) tested positive by SSST (4-h aldosterone level >165 pmol/L) compared with 8 (33%) by RSST (4-h plasma aldosterone level >140 pmol/L) (P < .001). RSST missed one unilateral, all bilateral, and four with as-yet undetermined subtype. RSST was positive in 7 of 10 (70%) posture-unresponsive vs one of 14 (7.1%) posture-responsive patients (P < .005). Conclusion: These preliminary results suggest that seated SST may be superior to recumbent SST in terms of sensitivity for detecting PA, especially posture-responsive forms, and may represent a reliable alternative to FST.
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subjectAdrenal Cortex Function Tests - methods ; Adrenals. Adrenal axis. Renin-angiotensin system (diseases) ; Adult ; Aged ; Aldosterone - blood ; Biological and medical sciences ; Endocrinopathies ; Feeding. Feeding behavior ; Female ; Fludrocortisone - administration & dosage ; Fundamental and applied biological sciences. Psychology ; Humans ; Hyperaldosteronism - blood ; Hyperaldosteronism - diagnosis ; Male ; Medical sciences ; Middle Aged ; Non tumoral diseases. Target tissue resistance. Benign neoplasms ; Pilot Projects ; Posture - physiology ; Renin - blood ; Sodium Chloride ; Vertebrates: anatomy and physiology, studies on body, several organs or systems ; Vertebrates: endocrinology
ispartofThe journal of clinical endocrinology and metabolism, 2014, Vol.99 (8), p.2745-2753
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0Ahmed, Ashraf H
1Cowley, Diane
2Wolley, Martin
3Gordon, Richard D
4Xu, Shengxin
5Taylor, Paul J
6Stowasser, Michael
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0Seated Saline Suppression Testing For The Diagnosis Of Primary Aldosteronism: A Preliminary Study
1The journal of clinical endocrinology and metabolism
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descriptionContext: Failure of aldosterone suppression by sodium loading during fludrocortisone suppression testing (FST) or saline suppression testing (SST) confirms primary aldosteronism (PA). We previously found recumbent SST (RSST) to lack sensitivity. Aldosterone levels can be higher upright (e.g. seated) than recumbent in patients with PA and upright levels are used during FST. We therefore hypothesized that seated SST (SSST) is more sensitive than RSST, especially for posture-responsive PA. Setting and Design: Of 66 patients who underwent FST (upright plasma aldosterone levels measured at 10am basally and after 4 days fludrocortisone 0.1 mg 6-hourly and oral salt loading), 31 underwent SST (aldosterone levels measured basally at 8am and after infusion of 2 L normal saline over 4h) both recumbent and seated in randomized order and at least 2 weeks apart. Results: FST confirmed PA in 23 of 31 patients (day 4 upright aldosterone level >165 pmol/L), excluded PA in three and was originally “inconclusive” in five. However, one with “inconclusive” FST had PA confirmed by lateralizing AVS and was reclassified “unilateral PA”. Of 24 with confirmed PA (eight unilateral, 11 bilateral, and five undetermined subtype), 23 (96%) tested positive by SSST (4-h aldosterone level >165 pmol/L) compared with 8 (33%) by RSST (4-h plasma aldosterone level >140 pmol/L) (P < .001). RSST missed one unilateral, all bilateral, and four with as-yet undetermined subtype. RSST was positive in 7 of 10 (70%) posture-unresponsive vs one of 14 (7.1%) posture-responsive patients (P < .005). Conclusion: These preliminary results suggest that seated SST may be superior to recumbent SST in terms of sensitivity for detecting PA, especially posture-responsive forms, and may represent a reliable alternative to FST.
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0Adrenal Cortex Function Tests - methods
1Adrenals. Adrenal axis. Renin-angiotensin system (diseases)
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6Endocrinopathies
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12Hyperaldosteronism - blood
13Hyperaldosteronism - diagnosis
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15Medical sciences
16Middle Aged
17Non tumoral diseases. Target tissue resistance. Benign neoplasms
18Pilot Projects
19Posture - physiology
20Renin - blood
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titleSeated Saline Suppression Testing For The Diagnosis Of Primary Aldosteronism: A Preliminary Study
authorAhmed, Ashraf H ; Cowley, Diane ; Wolley, Martin ; Gordon, Richard D ; Xu, Shengxin ; Taylor, Paul J ; Stowasser, Michael
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1Adrenals. Adrenal axis. Renin-angiotensin system (diseases)
2Adult
3Aged
4Aldosterone - blood
5Biological and medical sciences
6Endocrinopathies
7Feeding. Feeding behavior
8Female
9Fludrocortisone - administration & dosage
10Fundamental and applied biological sciences. Psychology
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12Hyperaldosteronism - blood
13Hyperaldosteronism - diagnosis
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notesThe work described in this report was funded by the Princess Alexandra Research Foundation and the Irene Patricia Hunt Memorial Trust for Hypertension Research.
abstractContext: Failure of aldosterone suppression by sodium loading during fludrocortisone suppression testing (FST) or saline suppression testing (SST) confirms primary aldosteronism (PA). We previously found recumbent SST (RSST) to lack sensitivity. Aldosterone levels can be higher upright (e.g. seated) than recumbent in patients with PA and upright levels are used during FST. We therefore hypothesized that seated SST (SSST) is more sensitive than RSST, especially for posture-responsive PA. Setting and Design: Of 66 patients who underwent FST (upright plasma aldosterone levels measured at 10am basally and after 4 days fludrocortisone 0.1 mg 6-hourly and oral salt loading), 31 underwent SST (aldosterone levels measured basally at 8am and after infusion of 2 L normal saline over 4h) both recumbent and seated in randomized order and at least 2 weeks apart. Results: FST confirmed PA in 23 of 31 patients (day 4 upright aldosterone level >165 pmol/L), excluded PA in three and was originally “inconclusive” in five. However, one with “inconclusive” FST had PA confirmed by lateralizing AVS and was reclassified “unilateral PA”. Of 24 with confirmed PA (eight unilateral, 11 bilateral, and five undetermined subtype), 23 (96%) tested positive by SSST (4-h aldosterone level >165 pmol/L) compared with 8 (33%) by RSST (4-h plasma aldosterone level >140 pmol/L) (P < .001). RSST missed one unilateral, all bilateral, and four with as-yet undetermined subtype. RSST was positive in 7 of 10 (70%) posture-unresponsive vs one of 14 (7.1%) posture-responsive patients (P < .005). Conclusion: These preliminary results suggest that seated SST may be superior to recumbent SST in terms of sensitivity for detecting PA, especially posture-responsive forms, and may represent a reliable alternative to FST.
copBethesda, MD
pubEndocrine Society
pmid24762111
doi10.1210/jc.2014-1153
oafree_for_read