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Horm Metab Res 2025; 57(03): 156-162
DOI: 10.1055/a-2528-7526
Original Article: Endocrine Care

Primary Aldosteronism: Clinical Characteristics of Patients with a Paradoxical Increase in P-Aldosterone in Response to Captopril Challenge Test

Camilla Grindskar
1   Department of Nephrology, Endocrinology and Metabolism, Copenhagen University Hospital – Rigshospitalet, Copenhagen, Denmark
,
Mikkel Andreassen
1   Department of Nephrology, Endocrinology and Metabolism, Copenhagen University Hospital – Rigshospitalet, Copenhagen, Denmark
2   Department of Clinical Medicine, University of Copenhagen, Copenhagen, Denmark
,
Claus Larsen Feltoft
3   Department of Endocrinology, Copenhagen University Hospital – Herlev, Herlev, Denmark
,
Ebbe Eldrup
3   Department of Endocrinology, Copenhagen University Hospital – Herlev, Herlev, Denmark
2   Department of Clinical Medicine, University of Copenhagen, Copenhagen, Denmark
,
Randi Kjærsgaard Ugleholdt
3   Department of Endocrinology, Copenhagen University Hospital – Herlev, Herlev, Denmark
2   Department of Clinical Medicine, University of Copenhagen, Copenhagen, Denmark
,
Niklas Rye Jørgensen
4   Translational Research Centre, Copenhagen University Hospital – Rigshospitalet, Copenhagen, Denmark
2   Department of Clinical Medicine, University of Copenhagen, Copenhagen, Denmark
5   Department of Clinical Biochemistry, Copenhagen University Hospital – Rigshospitalet, Copenhagen, Denmark
,
Sara Mørup
1   Department of Nephrology, Endocrinology and Metabolism, Copenhagen University Hospital – Rigshospitalet, Copenhagen, Denmark
,
Nathalie Voss
1   Department of Nephrology, Endocrinology and Metabolism, Copenhagen University Hospital – Rigshospitalet, Copenhagen, Denmark
,
Jesper Krogh
6   Clinic for Pituitary Disorders, Department of Medicine, Zealand University Hospital Koge, Koge, Denmark (Ringgold ID: RIN524788)
2   Department of Clinical Medicine, University of Copenhagen, Copenhagen, Denmark
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Abstract

A proportion of patients with primary aldosteronism (PA) have a paradox increasein plasma-Aldosterone (P-Aldosterone) concentration (PAC) during the Captopril Challenge Test (CCT). This study aimed to investigate if a paradoxical rise in PAC during CCT, was associated with clinical characteristics or outcomes inpatients with PA. We hypothesized that a paradoxical response to CCT is ameasure of disease severity, reflected by a higher baseline aldosterone/renin-ratio (ARR). A retrospective study of patients with PA,confirmed by CCT, who were referred for adrenal venous sampling between May 2011and August 2021 were eligible. Patients with an increase in PAC>10% frombaseline during CCT were classified as cases, while patients with 10 to 30% suppression were classified as controls. Of 167 patients referred, 116 (70%) were eligible for this study. Based on the CCT, 61/116 (53%) were classified as cases while 55/116 (47%) were classified as controls. The baseline ARR was 122 pmol/mIU (IQR: 65 to 223) for cases and 137 pmol/mIU (IQR: 65 to 223) for controls (p=0.66). Cases had lower systolic blood pressure (p=0.02) and higherpotassium levels (p=0.05) compared to controls. Complete clinical remission was obtained in 22 of 31 (71%) of the cases and 13 of 27 (48%) of the controls (p=0.03) after adrenalectomy. In conclusion, a paradoxical response to CCT wasnot associated with ARR. By contrast, patients with a paradoxical response did have lower systolic blood pressure, higher potassium levels, and markedly higher odds of full clinical remission after adrenalectomy.

Keywords

primary aldosteronism - captopril challenge test - paradoxical response - clinical remission

Supplementary Material



Publikationsverlauf

Eingereicht: 23. Oktober 2024

Angenommen nach Revision: 23. Januar 2025

Artikel online veröffentlicht:
06. März 2025

© 2025. Thieme. All rights reserved.

Georg Thieme Verlag KG
Oswald-Hesse-Straße 50, 70469 Stuttgart, Germany

 

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