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ORIGINAL RESEARCH article

Front. Endocrinol.
Sec. Adrenal Endocrinology
Volume 15 - 2024 | doi: 10.3389/fendo.2024.1495959

Impact of confirmatory test results on subtype classification and biochemical outcome following unilateral adrenalectomy in patients with primary aldosteronism

Provisionally accepted
Hediyeh Daneshpour Hediyeh Daneshpour 1Denise Brüdgam Denise Brüdgam 1Isabel Stüfchen Isabel Stüfchen 1Daniel Alexander Heinrich Daniel Alexander Heinrich 1Martin Bidlingmaier Martin Bidlingmaier 1Felix Beuschlein Felix Beuschlein 1,2,3Lydia Kürzinger Lydia Kürzinger 4Tracy Ann Williams Tracy Ann Williams 1Martin Reincke Martin Reincke 1Holger Schneider Holger Schneider 1Christian Adolf Christian Adolf 1*
  • 1 Medical Clinic and Polyclinic IV, LMU Munich University Hospital, Munich, Germany
  • 2 University Hospital Zürich, Zurich, Zürich, Switzerland
  • 3 The LOOP Zurich, Zurich, Switzerland
  • 4 University Hospital Würzburg, Würzburg, Bavaria, Germany

The final, formatted version of the article will be published soon.

    Primary aldosteronism (PA) is the most common form of endocrine hypertension. According to the Endocrine Society Practice Guidelines, the diagnosis of PA requires a pathological screening test result and non-suppressible aldosterone levels during confirmatory testing. Sequential testing with more than one confirmatory test may result in discordant test results.We investigated the association of discordant results of captopril challenge test (CCT) and saline infusion test (SIT) on patient subtype classification by adrenal vein sampling (AVS) and outcome in 111 consecutive patients from the German Conn's Registry. Concordance was defined as non-suppressible aldosterone levels upon both tests, while discordance was defined as conflicting test results. Patients with unilateral disease were offered adrenalectomy (ADX).Biochemical and clinical outcomes were assessed using the PASO criteria.85 of 111 (77%) patients had concordant results of CCT and SIT. Although baseline characteristics were comparable between patients with concordant and discordant tests, the latter had significantly lower aldosterone levels after testing (CCT: 170 vs. 114pg/ml; SIT: 139 vs. 101pg/ml; p=0.004).In 35% of patients with discordant (n=9) and 46% of concordant test results (n=39), AVS suggested lateralized PA. In 36 of 48 cases ADX was performed. 86% of patients with discordant and 72% with concordant results had complete biochemical success.The use of two confirmatory tests in patients with PA results in discordant results in approximately 23 % of cases. Patients having discordant confirmatory test results had a comparable rate of lateralized PA and underwent adrenalectomy with similar long-term outcome.

    Keywords: Aldosterone, Confirmatory test, Saline infusion test, Captopril challenge test, PASO criteria

    Received: 13 Sep 2024; Accepted: 05 Nov 2024.

    Copyright: © 2024 Daneshpour, Brüdgam, Stüfchen, Heinrich, Bidlingmaier, Beuschlein, Kürzinger, Williams, Reincke, Schneider and Adolf. This is an open-access article distributed under the terms of the Creative Commons Attribution License (CC BY). The use, distribution or reproduction in other forums is permitted, provided the original author(s) or licensor are credited and that the original publication in this journal is cited, in accordance with accepted academic practice. No use, distribution or reproduction is permitted which does not comply with these terms.

    * Correspondence: Christian Adolf, Medical Clinic and Polyclinic IV, LMU Munich University Hospital, Munich, Germany

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