Download PDF
Horm Metab Res 2012; 44(07): 527-532
DOI: 10.1055/s-0032-1314786
Humans, Clinical
© Georg Thieme Verlag KG Stuttgart · New York

Comparison of the Saline Infusion Test and the Fludrocortisone Suppression Test for the Diagnosis of Primary Aldosteronism

H. S. Willenberg
1   Department of Endocrinology, Diabetes and Rheumatology, Medical Faculty, Heinrich-Heine University Düsseldorf, Düsseldorf, Germany
2   Department of Medicine III, Technical University Dresden, Dresden, Germany
,
O. Vonend
3   Department of Nephrology, Medical Faculty, Heinrich-Heine University Düsseldorf, Düsseldorf, Germany
,
M. Schott
1   Department of Endocrinology, Diabetes and Rheumatology, Medical Faculty, Heinrich-Heine University Düsseldorf, Düsseldorf, Germany
,
X. Gao
3   Department of Nephrology, Medical Faculty, Heinrich-Heine University Düsseldorf, Düsseldorf, Germany
,
D. Blondin
4   Institute for Diagnostic and Interventional Radiology, Medical Faculty, Heinrich-Heine University Düsseldorf, Düsseldorf, Germany
,
A. Saleh
4   Institute for Diagnostic and Interventional Radiology, Medical Faculty, Heinrich-Heine University Düsseldorf, Düsseldorf, Germany
,
L. C. Rump
3   Department of Nephrology, Medical Faculty, Heinrich-Heine University Düsseldorf, Düsseldorf, Germany
,
W. A. Scherbaum
1   Department of Endocrinology, Diabetes and Rheumatology, Medical Faculty, Heinrich-Heine University Düsseldorf, Düsseldorf, Germany
› Author Affiliations
Further Information

Publication History

received 26 October 2011

accepted 26 April 2012

Publication Date:
11 June 2012 (online)

Also available at
    Permissions and Reprints

Abstract

For the diagnosis of primary aldosteronism (PA), confirmatory testing is mandatory and different function tests can be employed. There are, however, sparse data comparing the fludrocortisone suppression test (FST) and the saline infusion test (SIT). Patients with PA (n=90) or essential hypertension (n=65) were studied. They underwent one or the other test or both of them. Using the DPC Siemens aldosterone radioimmunoassay, we found that the SIT led to a stronger suppression of aldosterone than the FST. Post-test aldosterone-to-renin ratios (ARRs) and the percentage of suppression of aldosterone serum concentrations performed worse. The same results were observed in patients who underwent both FST and SIT. Some patients had divergent results in both tests. For the SIT, a lower cutoff value should be used than for the FST for the adequate identification of patients with unilateral PA. Long-term prospective studies are needed to address the question at what cutoff values patients benefit from subtype differentiation of PA. We discuss here possible explanations for divergent results obtained with both tests.

Key words

aldosterone - adrenal - fludrocortisones - hypertension
 

  • References

  • 1 Ehrhart-Bornstein M, Hinson JP, Bornstein SR, Scherbaum WA, Vinson GP. Intraadrenal interactions in the regulation of adrenocortical steroidogenesis. Endocr Rev 1998; 19: 101-143
    Search in Google Scholar
  • 2 Willenberg HS, Schinner S, Ansurudeen I. New mechanisms to control aldosterone synthesis. Horm Metab Res 2008; 40: 435-441
    Thieme ConnectPubMedSearch in Google Scholar
  • 3 Gomez-Sanchez CE, Rossi GP, Fallo F, Mannelli M. Progress in primary aldosteronism: present challenges and perspectives. Horm Metab Res 2010; 42: 374-381
    Thieme ConnectPubMedSearch in Google Scholar
  • 4 Tomaschitz A, Pilz S. Aldosterone to renin ratio - a reliable screening tool for primary aldosteronism?. Horm Metab Res 2010; 42: 382-391
    Thieme ConnectPubMedSearch in Google Scholar
  • 5 Mazzuco TL, Grunenwald S, Lampron A, Bourdeau I, Lacroix A. Aberrant hormone receptors in primary aldosteronism. Horm Metab Res 2010; 42: 416-423
    Thieme ConnectPubMedSearch in Google Scholar
  • 6 Funder JW, Carey RM, Fardella C, Gomez-Sanchez CE, Mantero F, Stowasser M, Young Jr WF, Montori VM. Case detection, diagnosis, and treatment of patients with primary aldosteronism: an endocrine society clinical practice guideline. J Clin Endocrinol Metab 2008; 93: 3266-3281
    Search in Google Scholar
  • 7 Giacchetti G, Ronconi V, Lucarelli G, Boscaro M, Mantero F. Analysis of screening and confirmatory tests in the diagnosis of primary aldosteronism: need for a standardized protocol. J Hypertens 2006; 24: 737-745
    CrossrefPubMedSearch in Google Scholar
  • 8 Rossi GP, Belfiore A, Bernini G, Desideri G, Fabris B, Ferri C, Giacchetti G, Letizia C, Maccario M, Mallamaci F, Mannelli M, Montemurro D, Palumbo G, Rizzoni D, Rossi E, Semplicini A, Agabiti-Rosei E, Pessina AC, Mantero F. PAPY Study Investigators . Prospective evaluation of the saline infusion test for excluding primary aldosteronism due to aldosterone-producing adenoma. J Hypertens 2007; 25: 1433-1442
    CrossrefPubMedSearch in Google Scholar
  • 9 Gordon RD. Mineralocorticoid hypertension. Lancet 1994; 23; 344: 240-243
    CrossrefPubMedSearch in Google Scholar
  • 10 Mulatero P, Milan A, Fallo F, Regolisti G, Pizzolo F, Fardella C, Mosso L, Marafetti L, Veglio F, Maccario M. Comparison of confirmatory tests for the diagnosis of primary aldosteronism. J Clin Endocrinol Metab 2006; 91: 2618-2623
    CrossrefPubMedSearch in Google Scholar
  • 11 Stowasser M, Gordon RD, Gunasekera TG, Cowley DC, Ward G, Archibald C, Smithers BM. High rate of detection of primary aldosteronism, including surgically treatable forms, after ‘non-selective’ screening of hypertensive patients. J Hypertens 2003; 21: 2149-2157
    Search in Google Scholar
  • 12 Fardella CE, Mosso L, Gómez-Sánchez C, Cortés P, Soto J, Gómez L, Pinto M, Huete A, Oestreicher E, Foradori A, Montero J. Primary hyperaldosteronism in essential hypertensives: prevalence, biochemical profile, and molecular biology. J Clin Endocrinol Metab 2000; 85: 1863-1867
    CrossrefPubMedSearch in Google Scholar
  • 13 Milliez P, Girerd X, Plouin PF, Blacher J, Safar ME, Mourad JJ. Evidence for an increased rate of cardiovascular events in patients with primary aldosteronism. J Am Coll Cardiol 2005; 45: 1243-1248
    Search in Google Scholar
  • 14 Born-Frontsberg E, Reincke M, Rump LC, Hahner S, Diederich S, Lorenz R, Allolio B, Seufert J, Schirpenbach C, Beuschlein F, Bidlingmaier M, Endres S, Quinkler M. Cardiovascular and cerebrovascular comorbidities of hypokalemic and normokalemic primary aldosteronism: results of the German Conn’s Registry. J Clin Endocrinol Metab 2009; 94: 1125-1130
    Search in Google Scholar
  • 15 Born-Frontsberg E, Reincke M, Beuschlein F, Quinkler M. Participants of German Conn’s Registry. Tumor size of Conn’s adenoma and comorbidities. Horm Metab Res 2009; 41: 785-788
    Thieme ConnectPubMedSearch in Google Scholar
  • 16 Quinkler M, Born-Frontsberg E, Fourkiotis VG. Comorbidities in primary aldosteronism. Horm Metab Res 2010; 42: 429-434
    Search in Google Scholar
  • 17 Rossi GP, Bernini G, Desideri G, Fabris B, Ferri C, Giacchetti G, Letizia C, Maccario M, Mannelli M, Matterello MJ, Montemurro D, Palumbo G, Rizzoni D, Rossi E, Pessina AC, Mantero F. Renal damage in primary aldosteronism: results of the PAPY Study. Hypertension 2006; 48: 232-238
    Search in Google Scholar
  • 18 Sechi LA, Novello M, Lapenna R, Baroselli S, Nadalini E, Colussi GL, Catena C. Long-term renal outcomes in patients with primary aldosteronism. JAMA 2006; 295: 2638-2645
    Search in Google Scholar
  • 19 Reincke M, Rump LC, Quinkler M, Hahner S, Diederich S, Lorenz R, Seufert J, Schirpenbach C, Beuschlein F, Bidlingmaier M, Meisinger C, Holle R, Endres S. Risk factors associated with a low glomerular filtration rate in primary aldosteronism. J Clin Endocrinol Metab 2009; 94: 869-875
    Search in Google Scholar
  • 20 Mulatero P, Stowasser M, Loh KC, Fardella CE, Gordon RD, Mosso L, Gomez-Sanchez CE, Veglio F, Young Jr WF. Increased diagnosis of primary aldosteronism, including surgically correctable forms, in centers from five continents. J Clin Endocrinol Metab 2004; 89: 1045-1050
    Search in Google Scholar
  • 21 Rossi GP, Bernini G, Caliumi C, Desideri G, Fabris B, Ferri C, Ganzaroli C, Giacchetti G, Letizia C, Maccario M, Mallamaci F, Mannelli M, Mattarello MJ, Moretti A, Palumbo G, Parenti G, Porteri E, Semplicini A, Rizzoni D, Rossi E, Boscaro M, Pessina AC, Mantero F. A prospective study of the prevalence of primary aldosteronism in 1 125 hypertensive patients. J Am Coll Cardiol 2006; 48: 2293-2300
    Search in Google Scholar
  • 22 Douma S, Petidis K, Doumas M, Papaefthimiou P, Triantafyllou A, Kartali N, Papadopoulos N, Vogiatzis K, Zamboulis C. Prevalence of primary hyperaldosteronism in resistant hypertension: a retrospective observational study. Lancet 2008; 371: 1921-1926
    Search in Google Scholar
  • 23 Connell JM, Fraser R, MacKenzie S, Davies E. Is altered adrenal steroid biosynthesis a key intermediate phenotype in hypertension?. Hypertension 2003; 41: 993-999
    CrossrefPubMedSearch in Google Scholar
  • 24 Willenberg HS, Kolentini C, Quinkler M, Cupisti K, Krausch M, Schott M, Scherbaum WA. The serum sodium to urinary sodium to (serum potassium)2 to urinary potassium (SUSPPUP) ratio in patients with primary aldosteronism. Eur J Clin Invest 2009; 39: 43-50
    CrossrefPubMedSearch in Google Scholar
  • 25 Tomaschitz A, Maerz W, Pilz S, Ritz E, Scharnagl H, Renner W, Boehm BO, Fahrleitner-Pammer A, Weihrauch G, Dobnig H. Aldosterone/renin ratio determines peripheral and central blood pressure values over a broad range. J Am Coll Cardiol 2010; 55: 2171-2180
    Search in Google Scholar
  • 26 Choi M, Scholl UI, Yue P, Björklund P, Zhao B, Nelson-Williams C, Ji W, Cho Y, Patel A, Men CJ, Lolis E, Wisgerhof MV, Geller DS, Mane S, Hellman P, Westin G, Åkerström G, Wang W, Carling T, Lifton RP. K+ channel mutations in adrenal aldosterone-producing adenomas and hereditary hypertension. Science 2011; 331: 768-772
    Search in Google Scholar
  • 27 Mulatero P, Monticone S, Bertello C, Mengozzi G, Tizzani D, Iannaccone A, Veglio F. Confirmatory tests in the diagnosis of primary aldosteronism. Horm Metab Res 2010; 42: 406-410
    Thieme ConnectPubMedSearch in Google Scholar