Department of Internal Medicine D and Hypertension Unit, the Chaim Sheba Medical Center, Tel-Hashomer, Israel.
Department of Medicine, Faculty of Medicine, Tel-Aviv University, Tel-Aviv, Israel.
Am J Hypertens. 2024 May 15;37(6):415-420. doi: 10.1093/ajh/hpae017.
The saline infusion test (SIT) to confirm primary aldosteronism requires infusing 2 L of normal saline over 240 minutes. Previous studies raised concerns regarding increased blood pressure and worsening hypokalemia during SIT. We aimed to evaluate the diagnostic applicability of a SIT that requires 1 L of saline infusion over 120 minutes.
A cross-sectional study, including all patients in a large medical center who underwent SIT from 1 January 2015 to 30 April 2023. Blood samples were drawn for baseline renin and aldosterone (t = 0) after 2 hours (t = 120 min) and after 4 hours (t = 240 min) of saline infusion. We used ROC analysis to evaluate the sensitivity and specificity of various aldosterone cut-off values at t = 120 to confirm primary aldosteronism.
The final analysis included 62 patients. A ROC analysis yielded 97% specificity and 90% sensitivity for a plasma aldosterone concentration (PAC) of 397 pmol/L (14 ng/dL) at t = 120 to confirm primary aldosteronism, and an area under the curve of 0.97 (95% CI [0.93, 1.00], P < 0.001). Almost half (44%) of the patients did not suppress PAC below 397 pmol/L (14 ng/dL) at t = 120. Of them, only one (4%) patient suppressed PAC below 276 pmol/L (10 ng/dL) at t = 240. Mean systolic blood pressure increased from 140.1 ± 21.3 mm Hg at t = 0 to 147.6 ± 14.5 mm Hg at t = 240 (P = 0.011).
A PAC of 397 pmol/L (14 ng/dL) at t = 120 has high sensitivity and specificity for primary aldosteronism confirmation.
盐皮质激素过多症的盐水输注试验（SIT）需要在 240 分钟内输注 2 升生理盐水。之前的研究对 SIT 期间血压升高和低钾血症恶化表示担忧。我们旨在评估需要在 120 分钟内输注 1 升生理盐水的 SIT 的诊断适用性。
一项横断面研究，纳入了 2015 年 1 月 1 日至 2023 年 4 月 30 日期间在一家大型医疗中心接受 SIT 的所有患者。在输注生理盐水 2 小时（t = 120 分钟）和 4 小时（t = 240 分钟）后采集基线肾素和醛固酮血样（t = 0）。我们使用 ROC 分析评估 t = 120 时各种醛固酮切点值的敏感性和特异性，以确认原发性醛固酮增多症。
最终分析包括 62 例患者。ROC 分析显示，t = 120 时血浆醛固酮浓度（PAC）为 397 pmol/L（14ng/dL）时，诊断原发性醛固酮增多症的特异性为 97%，敏感性为 90%，曲线下面积为 0.97（95%CI [0.93, 1.00]，P < 0.001）。几乎一半（44%）的患者在 t = 120 时未将 PAC 抑制到 397 pmol/L（14ng/dL）以下。其中，只有 1 例（4%）患者在 t = 240 时将 PAC 抑制到 276 pmol/L（10ng/dL）以下。收缩压从 t = 0 时的 140.1 ± 21.3mmHg 升高至 t = 240 时的 147.6 ± 14.5mmHg（P = 0.011）。
t = 120 时 PAC 为 397 pmol/L（14ng/dL）对原发性醛固酮增多症的确诊具有较高的敏感性和特异性。
