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SFE/SFHTA/AFCE consensus on primary aldosteronism, part 3: Confirmatory testing.

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Summary

The aldosterone/renin ratio (ARR) helps assess primary aldosteronism (PA) risk. Specific confirmatory tests are recommended for uncertain cases, with saline infusion testing preferred.

Keywords:
AldosteroneAldostéroneConfirmatory testingHyperaldostéronisme primairePrimary aldosteronismReninRénineTest de confirmation

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Area of Science:

  • Endocrinology
  • Clinical Diagnostics

Background:

  • The aldosterone/renin ratio (ARR) is used to screen for primary aldosteronism (PA).
  • Current ARR screening has suboptimal sensitivity and specificity, necessitating further confirmatory testing in many patients.
  • Confirmatory testing is crucial for accurate PA diagnosis and management.

Framework:

  • Defines clear criteria for diagnosing PA without confirmatory tests based on ARR and plasma aldosterone concentration (PAC).
  • Elevated ARR and PAC > 550 pmol/L on two occasions confirms PA.
  • Normal ARR and PAC < 240 pmol/L on two occasions rules out PA.

Implementation:

  • Dynamic confirmatory testing is mandatory for patients not meeting exclusion or inclusion criteria.
  • Available tests include saline suppression, fludrocortisone suppression, captopril inhibition, and furosemide stimulation.
  • The saline infusion test is recommended, with captopril renin stimulation as an alternative if sodium loading is contraindicated.

Implications:

  • Standardizes diagnostic pathways for primary aldosteronism.
  • Improves diagnostic accuracy by guiding the necessity of confirmatory testing.
  • Provides evidence-based recommendations for selecting appropriate confirmatory tests.