title: Diagnostics of primary aldosteronism: is obligatory use of confirmatory tests justified?
abstract: BACKGROUND
  Assessment of the renin-angiotensin-aldosterone system has been recently granted a much greater role in the evaluation of patients with arterial hypertension. There is no single test efficient in selection of patients for second-step etiological investigation.
  
  
  METHODS
  Altogether, 198 consecutive patients--119 women (60%) and 79 men (40%)--hospitalized in years 2009-2011 at the Clinical Department of Endocrinology Medical University of Bialystok were diagnosed with primary aldosteronism. In each patient, plasma renin activity and plasma aldosterone concentration (basic and after 2 l NaCl infusion) were evaluated.
  
  
  RESULTS
  The percentage of patients with plasma aldosterone concentration ≥ 15 ng/ml was 53 and the percentage of patients with plasma renin activity ≤ 0.1 ng/ml/h was 20. The percentage of patients screened for primary aldosteronism in which the aldosterone:renin ratio exceeded consecutive cut-offs of 20, 30, 40 and 50 were respectively 57, 45, 34 and 29. Among 15 patients in which plasma aldosterone concentration after infusion of 2 l of saline was ≥ 6.5 ng/dl (8.6%), 13 (6.6%) were diagnosed with primary aldosteronism.
  
  
  CONCLUSIONS
  The obligatory use of tests confirming autonomy of aldosterone secretion in patients screened for primary aldosteronism seems cost-effective in limiting the number of patients for further diagnosis.
authors.affiliation: Department of Endocrinology, Diabetology and Internal Diseases, Medical University of Bialystok, 15-276 Białystok, Poland. janusz.mysliwiec@umb.edu.pl
authors.forename: Janusz
authors.initials: J
authors.lastname: Myśliwiec
authors.forename: Łukasz
authors.initials: Ł
authors.lastname: Zukowski
authors.forename: Anna
authors.initials: A
authors.lastname: Grodzka
authors.forename: Agata
authors.initials: A
authors.lastname: Piłaszewicz
authors.forename: Szymon
authors.initials: S
authors.lastname: Dragowski
authors.forename: Maria
authors.initials: M
authors.lastname: Górska
mesh_terms: D000450:Aldosterone / Q000097:blood; D003955:Diagnostic Tests, Routine / Q000379:methods*; D005260:Female; D006801:Humans; D006929:Hyperaldosteronism / Q000097:blood / Q000175:diagnosis*; D008297:Male; D008875:Middle Aged; D012372:ROC Curve; D012083:Renin / Q000097:blood; D015203:Reproducibility of Results; D012965:Sodium Chloride / Q000008:administration & dosage
chemical_list: D012965:Sodium Chloride; D000450:Aldosterone; D012083:Renin