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Exclusion Tests in Unilateral Primary Aldosteronism (ExcluPA) Study
Rui Zhu1,2, Tungalagtamir Shagjaa1,3, Giacomo Rossitto1,4
1Internal & Emergency Medicine Unit, Department of Medicine - DIMED, University of Padua, 35128 Padua, Italy.
The Journal of Clinical Endocrinology and Metabolism
|November 14, 2022
Summary
Exclusion tests for primary aldosteronism (PA) show similar accuracy to the aldosterone to renin ratio (ARR). Available evidence does not support the routine clinical use of captopril challenge (CCT) or saline infusion tests (SIT) over ARR.
Area of Science:
- Endocrinology
- Diagnostic Accuracy
- Clinical Trials
Background:
- Primary aldosteronism (PA) diagnosis requires accurate screening tests to avoid unnecessary invasive procedures.
- The aldosterone to renin ratio (ARR) is a common screening tool, but its accuracy compared to exclusion tests needs evaluation.
Approach:
- A systematic review and two-stage meta-analysis of 31 datasets (4242 patients) were conducted.
- Searched PubMed, EMBASE, Web of Science, and Cochrane Library (1970-2021) for relevant studies.
- Analyzed pooled specificity, negative likelihood ratio, diagnostic odds ratio, and summary area under the ROC curve (sAUROC).
Key Points:
- Pooled accuracy (sAUROC) did not significantly differ between ARR (0.95), captopril challenge test (CCT) (0.92), and saline infusion test (SIT) (0.96).
- High accuracy for CCT and SIT was observed in patients with pre-selected high ARR, indicating no additional diagnostic gain.
- Limited data were available for fludrocortisone suppression and furosemide upright tests.
Conclusions:
- Exclusion tests like CCT and SIT do not offer a diagnostic advantage over ARR for primary aldosteronism.
- Current evidence does not justify the systematic use of these exclusion tests in clinical practice.
- Accurate screening for PA remains crucial to guide further diagnostic and treatment pathways.
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