The role of confirmatory tests in the diagnosis of primary aldosteronism

Chien Wei Huang, Kun Hua Tu, Kang Chih Fan, Cheng Hsuan Tsai, Wei Ting Wang, Shu Yi Wang, Chun Yi Wu, Ya Hui Hu, Shu Heng Huang, Han Wen Liu, Fen Yu Tseng, Wan Chen Wu, Chin Chen Chang, Yen Hung Lin, Vin Cent Wu, Chii Min Hwu

研究成果: 雜誌貢獻回顧型文獻同行評審

4 引文 斯高帕斯(Scopus)

摘要

Confirmatory tests for diagnosis of primary aldosteronism (PA) play an important role in sparing patients with a false-positive aldosterone-to-renin ratio (ARR) screening test from undergoing invasive subtyping procedures. We recommend that patients with a positive ARR test should undergo at least one confirmatory test to confirm or exclude the diagnosis of PA before directly proceeding to subtype studies, except for patients with significant PA phenotypes, including spontaneous hypokalemia, plasma aldosterone concentration >20 ng/dL plus plasma renin activity below a detectable level. Although a gold standard confirmatory test has not been identified, we recommend that saline infusion test and captopril challenge test, which were widely used in Taiwan. Patients with PA have been reported to have a higher prevalence of concurrent autonomous cortisol secretion (ACS). ACS is a biochemical condition of mild cortisol overproduction from adrenal lesions, but without the typical clinical features of overt Cushing's syndrome. Concurrent ACS may result in incorrect interpretation of adrenal venous sampling (AVS) and may lead to adrenal insufficiency after adrenalectomy. We recommend screening for ACS in patients with PA scheduled for AVS examinations as well as for adrenalectomy. We recommend the 1-mg overnight dexamethasone suppression test as screening method to detect ACS.
原文英語
頁(從 - 到)S104-S113
期刊Journal of the Formosan Medical Association
123
DOIs
出版狀態接受/付印 - 2023

ASJC Scopus subject areas

  • 一般醫學

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