Plasma Aldosterone after Seated Saline Infusion Test Outperforms Captopril Test at Predicting Clinical Outcomes after Adrenalectomy for Primary Aldosteronism

Che Hsiung Wu, Vincent Wu, Ya Wen Yang, Yen Hung Lin, Shao Yu Yang, Po Chih Lin, Chin Chen Chang, Yao Chou Tsai, Shuo Meng Wang

Research output: Contribution to journalArticle

2 Citations (Scopus)

Abstract

OBJECTIVE: The saline infusion test (SIT) and the captopril test (CT) are widely used as confirmatory tests for primary aldosteronism (PA). We hypothesized that post-SIT and post-CT plasma aldosterone concentrations (PAC) indicate the severity of aldosterone-producing adenoma (APA) and might predict clinical outcome. METHODS: We recruited 216 patients with APA in the Taiwan Primary Aldosteronism Investigation (TAIPAI) registry who received both seated SIT and CT as confirmatory tests. The data of 143 patients who underwent adrenalectomy with complete follow-up after diagnosis were included in the final analysis. We determined the proportion of patients achieving clinical success in accordance with the Primary Aldosteronism Surgical Outcome consensus. Logistic regression analysis was conducted to identify preoperative factors associated with cure of hypertension. RESULTS: Complete clinical success was achieved in 48 (33.6%) patients and partial clinical success in 59 (41.2%) patients; absent clinical success was seen in 36 (25.2%) of 143 patients. Post-SIT PAC but not post-CT PAC was independently associated with clinical outcome. Higher levels of post-SIT PAC had a higher likelihood of clinical benefit (complete plus partial clinical success; odds ratio = 1.04 per ng/dl increase, 95% confidence interval = 1.01, 1.06; P = 0.004). Patients with post-SIT PAC > 25 ng/dl were more likely to have a favorable clinical outcome after adrenalectomy. This cutoff value translated into a positive predictive value of 86.0%. CONCLUSIONS: We suggest that post-SIT PAC is a better predictor than post-CT PAC for clinical success in PA post adrenalectomy.

Original languageEnglish
Pages (from-to)1066-1074
Number of pages9
JournalAmerican Journal of Hypertension
Volume32
Issue number11
DOIs
Publication statusPublished - Oct 16 2019
Externally publishedYes

Keywords

  • adrenalectomy
  • blood pressure
  • hypertension
  • outcome
  • primary aldosteronism

ASJC Scopus subject areas

  • Internal Medicine

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