Younes Nada, St-Jean Matthieu, Desrochers Marie-Josée, Therasse Eric, Latour Mathieu, Bourdeau Isabelle, Lacroix André
Division of Endocrinology, Department of Medicine and Research Center, Centre hospitalier de l'Université de Montréal, Montréal, Québec, Canada, H2X 0A9.
Division of Endocrinology, Department of Medicine, Centre hospitalier de l'Université de Sherbrooke, Sherbrooke, Québec, Canada, J1H 5H3.
J Endocr Soc. 2024 Sep 4;8(10):bvae155. doi: 10.1210/jendso/bvae155. eCollection 2024 Aug 27.
To assess the usefulness of the upright posture stimulation test (UPT) in the confirmation of primary aldosteronism (PA) in patients in whom saline tests (ST) were inconclusive.
One hundred eighty-seven adult patients with possible PA were retrospectively included and compared to 25 control subjects. Blood samples were obtained after a 1-hour supine posture and during 2 hours of ambulation. An increase in plasma aldosterone concentration (PAC) ≥ 50% with a suppressed renin (≤10.1 ng/L; ≤1 ng/mL/hour) and a cortisol increase ≤50% were considered abnormal.
PA patients had higher basal PAC and lower basal direct renin concentration (DRC) ( < .0001) and a higher maximal PAC ( = .0025) and lower maximal DRC (DRC) ( < .0001) during UPT compared to controls. PA was confirmed in 145 patients (77.5%), based on either oral/IV ST or UPT. DRC ≤12 ng/L during UPT was a predictor of PA (receiver operating characteristic curve sensitivity 93.8%, specificity 88%), and 95.6% of PA patients increased PAC ≥50% on UPT (median 222.2%), while renin remained suppressed. All 41 PA patients with false-negative IV ST (PAC < 162 pmol/L) and 88.9% with borderline response (162-240 pmol/L) had a DRC ≤12, while, respectively, 97.6% and 100% increased aldosterone by ≥50%. Similar responses to UPT were found in lateralized (28/63) and bilateral PA source (35/63). PA diagnosis increased from 23.6% to 88.8% using UPT results instead of IV ST and were confirmed at pathology and clinical outcome after adrenalectomy (n = 22).
UPT can be useful to confirm PA, particularly in patients with suspected false-negative ST.
评估直立姿势刺激试验（UPT）在盐水试验（ST）结果不明确的患者中确诊原发性醛固酮增多症（PA）的有效性。
回顾性纳入187例可能患有PA的成年患者，并与25例对照受试者进行比较。在1小时仰卧姿势后以及步行2小时期间采集血样。血浆醛固酮浓度（PAC）升高≥50%且肾素抑制（≤10.1 ng/L；≤1 ng/mL/小时）以及皮质醇升高≤50%被视为异常。
与对照组相比，PA患者在UPT期间的基础PAC更高，基础直接肾素浓度（DRC）更低（<0.0001），最大PAC更高（=0.0025），最大DRC更低（DRC）（<0.0001）。基于口服/静脉ST或UPT，145例患者（77.5%）确诊为PA。UPT期间DRC≤12 ng/L是PA的预测指标（受试者工作特征曲线敏感性93.8%，特异性88%），95.6%的PA患者在UPT时PAC升高≥50%（中位数222.2%），而肾素仍被抑制。所有41例静脉ST假阴性（PAC<162 pmol/L）的PA患者和88.9%临界反应（162 - 240 pmol/L）的患者DRC≤12，而醛固酮分别有97.6%和100%升高≥5p0%。在单侧（28/63）和双侧PA来源（35/63）中发现对UPT有相似反应。使用UPT结果而非静脉ST，PA诊断率从23.6%提高到88.8%，并在肾上腺切除术后经病理和临床结果证实（n = 22）。
UPT有助于确诊PA，尤其是在疑似ST假阴性患者中。
