Overnight Dexamethasone in Primary Aldosteronism Screening in Patients on Interfering Therapy (ODEPRASC): A...

Area of Science:

• Endocrinology
• Hypertension Management
• Diagnostic Accuracy

Background:

• Primary aldosteronism (PA) is a frequent cause of hypertension (HT), yet screening rates are low.
• Current PA diagnostic guidelines recommend medication withdrawal, which is often impractical.
• Previous methods combining objective thresholds and 2-day cosyntropin suppression showed high accuracy in specific patient groups.

Purpose of the Study:

• To develop and validate aldosterone-to-renin ratio (ARR) thresholds for PA screening using overnight cosyntropin suppression.
• To assess the diagnostic interpretability of PA screening in patients taking interfering medications.
• To provide an optimized diagnostic approach for PA, addressing low screening rates.

Main Methods:

• A single-center study with development and confirmation cohorts (n=80 each).
• Patients with adrenal incidentaloma undergo a 1-day clinic evaluation.
• Aldosterone-to-renin ratios (ARRs) measured before and after overnight 1mg dexamethasone (DXM) intake, with varying degrees of RAAS-interfering medication withdrawal.

Main Results:

• The study protocol aims to generate and validate ARR thresholds for PA screening.
• Hypothesis: Overnight DXM suppression will yield 25% higher diagnostic interpretability than conventional ARR testing.
• The ODEPRASC study is designed to address limitations in current PA diagnostic protocols.

Conclusions:

• The proposed overnight cosyntropin suppression test offers a potentially more practical and accurate method for PA screening.
• This approach may improve PA diagnosis rates, especially in patients on interfering medications.
• Findings could inform future guidelines for PA diagnosis and management.