title: A new highly sensitive and specific overnight combined screening and diagnostic test for primary aldosteronism.
abstract: BACKGROUND
  Primary aldosteronism (PA) is the most common cause of endocrine hypertension that is diagnosed following a two-step process: an initial screening test, based on the serum aldosterone-to-renin ratio (ARR), followed by a relatively laborious and time-consuming confirmatory test to document autonomous aldosterone (ALD) secretion.
  
  
  OBJECTIVE
  The aim of this study is to develop a simple overnight test for the early and definite diagnosis of PA.
  
  
  METHODS
  Totally, 148 hypertensive patients underwent a fludrocortisone-dexamethasone suppression test (FDST) and the new overnight diagnostic test (DCVT) using pharmaceutical RAAS (renin-angiotensin-aldosterone system) blockade with dexamethasone, captopril and valsartan.
  
  
  RESULTS
  Of the 148 patients, 45 were diagnosed as having PA and they all normalized their elevated blood pressure (BP) after administration of spironolactone or eplerenone. The remaining 103 patients were considered as having essential hypertension and served as controls. Using ROC analysis, the estimated sensitivity and specificity were 91 and 100%, respectively, for the post-FDST ARR, whereas 98% and 89% and 100% and 82% for the post-DCVT ARR and post-DCVT ALD, respectively, with selected cutoffs of 0.32ng/dL/μU/mL and 3ng/dL respectively. However, considering these cutoffs simultaneously, the estimated sensitivity and specificity were 98 and 100% respectively. Applying these cutoffs, the diagnosis of PA was confirmed in 44 (98%) of the 45 patients who were considered to have the disease.
  
  
  CONCLUSIONS
  In this study, a highly sensitive and specific, low-cost, rapid, safe, and easy-to-perform diagnostic test (DCVT) for PA is described, which could be utilized on an outpatient basis potentially substituting conventional laborious testing.
authors.affiliation: Department of Endocrinology and Diabetes Centre"G. Gennimatas" Athens General Hospital, Athens, Greece vaiostsiavos@gmail.com.
authors.forename: Vaios
authors.initials: V
authors.lastname: Tsiavos
authors.affiliation: Department of Endocrinology and Diabetes Centre"G. Gennimatas" Athens General Hospital, Athens, Greece.
authors.forename: Athina
authors.initials: A
authors.lastname: Markou
authors.affiliation: Department of Endocrinology and Diabetes Centre"G. Gennimatas" Athens General Hospital, Athens, Greece.
authors.forename: Labrini
authors.initials: L
authors.lastname: Papanastasiou
authors.affiliation: Department of Endocrinology and Diabetes Centre"G. Gennimatas" Athens General Hospital, Athens, Greece.
authors.forename: Theodora
authors.initials: T
authors.lastname: Kounadi
authors.affiliation: Department of Endocrinology and Diabetes Centre"G. Gennimatas" Athens General Hospital, Athens, Greece.
authors.forename: Ioannis I
authors.initials: II
authors.lastname: Androulakis
authors.affiliation: Department of Endocrinology and Diabetes Centre"G. Gennimatas" Athens General Hospital, Athens, Greece.
authors.forename: Nick
authors.initials: N
authors.lastname: Voulgaris
authors.affiliation: Department of Endocrinology and Diabetes Centre"G. Gennimatas" Athens General Hospital, Athens, Greece.
authors.forename: Aglaia
authors.initials: A
authors.lastname: Zachaki
authors.affiliation: Department of Biological ChemistryMedical School, National and Kapodistrian University of Athens, Athens, Greece.
authors.forename: Eva
authors.initials: E
authors.lastname: Kassi
authors.affiliation: Department of PathophysiologyLaikon Hospital, School of Medicine, University of Athens, Athens, Greece.
authors.forename: Gregory
authors.initials: G
authors.lastname: Kaltsas
authors.affiliation: First Department of PaediatricsChildren's Hospital Aghia Sophia, School of Medicine, University of Athens, Athens, Greece.
authors.forename: George P
authors.initials: GP
authors.lastname: Chrousos
authors.affiliation: Department of Endocrinology and Diabetes Centre"G. Gennimatas" Athens General Hospital, Athens, Greece.
authors.forename: George P
authors.initials: GP
authors.lastname: Piaditis
mesh_terms: D000328:Adult; D000368:Aged; D000450:Aldosterone / Q000097:blood; D002216:Captopril; D003907:Dexamethasone; D003955:Diagnostic Tests, Routine; D005260:Female; D006801:Humans; D006929:Hyperaldosteronism / Q000097:blood / Q000175:diagnosis* / Q000503:physiopathology; D006973:Hypertension / Q000097:blood / Q000175:diagnosis* / Q000503:physiopathology; D008297:Male; D008403:Mass Screening; D008875:Middle Aged; D010912:Pituitary-Adrenal Function Tests; D012083:Renin / Q000097:blood; D012084:Renin-Angiotensin System / Q000502:physiology*; D012680:Sensitivity and Specificity
chemical_list: D000450:Aldosterone; D003907:Dexamethasone; D002216:Captopril; D012083:Renin