Efficacy of screening for primary aldosteronism by adrenocortical scintigraphy without discontinuing antihypertensive medication.
BACKGROUND
Recently, it has been proposed that discontinuation of antihypertensive medications is not necessarily essential for the measurement of plasma aldosterone-to-renin ratios. We examined the efficacy of adrenocortical scintigraphy performed without modification of antihypertensive medications.


METHODS
A retrospective study was conducted on 119 patients, in whom functional tests, anatomic studies, and adrenocortical scintigraphy were replete. Interrelationship among these was studied. The patients tested were being treated with antihypertensive medications from several classes including angiotensin-converting enzyme inhibitors, calcium antagonists, beta-blockers, diuretics, and spironolactone.


RESULTS
Significantly higher percentage of scintigraphy positive patients had plasma aldosterone-to-renin ratio of greater than 25:1. Positive rate for adrenal nodules by anatomic studies was significantly higher in the scintigraphy positive patients than in the scintigraphy negative patients. Finally, the percentage of patients who underwent adrenalectomy was higher in the scintigraphy positive patients than in the scintigraphy negative patients.


CONCLUSIONS
We conclude that adrenocortical scintigraphy is a valid evaluation tool for primary aldosteronism and that the discontinuation of antihypertensive medications is not a requirement for this test.
Nakahama
Hajime
H
Division of Hypertension and Nephrology, National Cardiovascular Center, Fujishirodai 5-7-1, Suita 565-8565, Osaka, Japan. hnakaham@hsp.ncvc.go.jp
Fukuchi
Kazuki
K
Yoshihara
Fumiki
F
Nakamura
Satoko
S
Inenaga
Takashi
T
Takiuchi
Shin
S
Kamide
Kei
K
Horio
Takeshi
T
Kawano
Yuhei
Y
D000328:Adult; D000368:Aged; D000450:Aldosterone / Q000097:blood; D000959:Antihypertensive Agents / Q000627:therapeutic use*; D015415:Biomarkers / Q000097:blood; D005260:Female; D006801:Humans; D006929:Hyperaldosteronism / Q000097:blood / Q000000981:diagnostic imaging* / Q000188:drug therapy*; D007564:Japan; D008297:Male; D008403:Mass Screening; D008875:Middle Aged; D000451:Mineralocorticoid Receptor Antagonists / Q000627:therapeutic use; D011188:Potassium / Q000097:blood; D011877:Radionuclide Imaging; D012083:Renin / Q000097:blood; D012189:Retrospective Studies; D013148:Spironolactone / Q000627:therapeutic use; D013223:Statistics as Topic; D016896:Treatment Outcome
D000959:Antihypertensive Agents; D015415:Biomarkers; D000451:Mineralocorticoid Receptor Antagonists; D013148:Spironolactone; D000450:Aldosterone; D012083:Renin; D011188:Potassium