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Comparison of the shortened and standard saline infusion tests for primary aldosteronism diagnostics

Hypertension Research volume 43, pages 1113–1121 (2020)Cite this article

Abstract

The saline infusion test (SIT) is widely used to confirm PA, but some patients may not tolerate the standard loading volume of 2 L saline over 4 h. The shortened SIT, loading only 1 L saline over 2 h, is suggested to be useful and would be more acceptable if the diagnostic utility of the shortened SIT is comparable to that of the standard SIT. We compared the diagnostic values of the plasma aldosterone concentration after 2 h of 1 L saline loading (2 h PAC) and that after 4 h of 2 L saline loading (4 h PAC) for the prediction of unilateral aldosterone hypersecretion and postoperative outcome. This retrospective, single-center study involved 555 PA-suspected patients who underwent SIT, 153 patients with adrenal vein sampling (AVS) results, and 37 patients with a 1-year postoperative evaluation. To detect the Japanese cutoff of 4 h PAC > 60 pg/mL, a 2-h PAC Youden Index at 66 pg/mL showed 91% sensitivity and 75% specificity. For unilateral aldosterone hypersecretion, the sensitivity and specificity of 2 h PAC were not inferior to those of 4 h PAC by Markov chain Monte Carlo (MCMC) methods. The sensitivity and specificity of 2 h PAC for postoperative reduction of anti-hypertensive drugs were also not inferior to those of 4 h PAC. Although using the 2 h PAC > 66 pg/mL cutoff may increase false positives for PA diagnosis, the shortened SIT, possibly using a cutoff value higher than 66 pg/mL, may be as useful as the standard SIT for selecting PA patients for AVS and to predict postoperative outcomes with reduced burden on patients.

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Acknowledgements

We would like to thank the ward staff and doctors for conducting SIT and AVS.

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Authors and Affiliations

  1. Department of Endocrinology and Hypertension, Tokyo Women’s Medical University, Tokyo, Japan

    Kaoru Yamashita, Midori Yatabe, Yasufumi Seki, Kanako Bokuda, Daisuke Watanabe, Satoshi Morimoto & Atsuhiro Ichihara

  2. Department of Medical Education, Tokyo Women’s Medical University, Tokyo, Japan

    Satoru Shimizu

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  1. Kaoru Yamashita
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  2. Midori Yatabe
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Correspondence to Midori Yatabe.

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Yamashita, K., Yatabe, M., Seki, Y. et al. Comparison of the shortened and standard saline infusion tests for primary aldosteronism diagnostics. Hypertens Res 43, 1113–1121 (2020). https://doi.org/10.1038/s41440-020-0454-9

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