Endocrine Hypertension Research Centre, University of Queensland Diamantina Institute, Greenslopes and Princess Alexandra Hospitals, Brisbane, Australia.
Department of Chemical Pathology, Pathology Queensland, Queensland Health, Brisbane, Australia.
J Clin Endocrinol Metab. 2018 Nov 1;103(11):4113-4124. doi: 10.1210/jc.2018-01394.
Failure of plasma aldosterone suppression during fludrocortisone suppression testing (FST) or saline suppression testing (SST) confirms primary aldosteronism (PA). Aldosterone is often higher upright than recumbent in PA; upright levels are used during FST. In a pilot study (24 patients with PA), seated saline suppression testing (SSST) was more sensitive than recumbent saline suppression testing (RSST).
OBJECTIVE, DESIGN, AND PATIENTS: The current validation study involved 100 patients who underwent FST, RSST, and SSST, eight before and after unilateral adrenalectomy. Of the 108 FSTs, 73 confirmed and 18 excluded PA. Four patients with inconclusive FST lateralized on adrenal venous sampling, making a total of 77 with PA.
The area under the receiver operating characteristic (ROC) curve was greater for SSST than RSST (0.96 vs. 0.80; P < 0.01). ROC analysis predicted optimal cutoff aldosterone levels of 162 pmol/L for SSST and 106 pmol/L for RSST. At these cutoffs, SSST showed high sensitivity for PA (87%) that markedly exceeded that for RSST (38%; P < 0.001) but similar specificity (94 vs. 94%; not significant). SSST was more sensitive than RSST in detecting both unilateral (n = 28, 93% vs. 68%, P < 0.05) and bilateral (n = 40, 85% vs. 20%, P < 0.001) forms of PA. Only three SSST (vs. 9 RSST and 17 FST) results were inconclusive.
SSST is highly sensitive and superior to RSST in identifying both unilateral and bilateral forms of PA and has a low rate of false positives and inconclusive results. It therefore offers a reliable and much less complicated and expensive alternative to FST for confirming PA.
在氟氢可的松抑制试验（FST）或盐水抑制试验（SST）中，血浆醛固酮抑制失败可确诊为原发性醛固酮增多症（PA）。在 PA 中，站立位时的醛固酮通常高于卧位；FST 期间使用站立位水平。在一项初步研究（24 例 PA 患者）中，坐位盐水抑制试验（SSST）比卧位盐水抑制试验（RSST）更敏感。
目的、设计和患者：本验证研究纳入了 100 例接受 FST、RSST 和 SSST 的患者，其中 8 例在单侧肾上腺切除术前后接受了检查。在 108 次 FST 中，73 次证实了 PA，18 次排除了 PA。4 例 FST 不确定的患者行肾上腺静脉采样定位，最终共有 77 例患者被确诊为 PA。
SSST 的受试者工作特征（ROC）曲线下面积大于 RSST（0.96 比 0.80；P<0.01）。ROC 分析预测 SSST 的最佳截断醛固酮水平为 162 pmol/L，RSST 的最佳截断醛固酮水平为 106 pmol/L。在此截断值下，SSST 对 PA 的敏感性较高（87%），明显高于 RSST（38%；P<0.001），但特异性相似（94%比 94%；无统计学意义）。SSST 比 RSST 更敏感，可检测单侧（n=28，93%比 68%，P<0.05）和双侧（n=40，85%比 20%，P<0.001）PA。SSST 只有 3 次（RSST 有 9 次，FST 有 17 次）结果不确定。
SSST 高度敏感，优于 RSST，可识别单侧和双侧 PA，且假阳性率和不确定结果率较低。因此，SSST 为 FST 提供了一种可靠、简便且经济的替代方法，用于确诊 PA。
