Abstract: LB SAT 66

Combination of ARR and PAC for a screening of PA

Presenter: Yui Shibayama


Abstract


Objectives: In primary aldosteronism (PA), although aldosterone/renin ratio (ARR) has been utilized as the most reliable screening test of PA, very low plasma renin activity (PRA) could cause a false positive result even if plasma aldosterone concentration (PAC) is not increased. Some investigators included a minimum PAC of 150pg/ml for the screening criterion. Others indicated 100pg/ml to reduce the risk of the missing aldosterone producing adenoma (APA). view more

Objectives: In primary aldosteronism (PA), although aldosterone/renin ratio (ARR) has been utilized as the most reliable screening test of PA, very low plasma renin activity (PRA) could cause a false positive result even if plasma aldosterone concentration (PAC) is not increased. Some investigators included a minimum PAC of 150pg/ml for the screening criterion. Others indicated 100pg/ml to reduce the risk of the missing aldosterone producing adenoma (APA). The aim of this study is to investigate the significance of basal PAC added on ARR for diagnosis of the unilateral disease.

Patients and Methods: This study was conducted as a part of a multi-center collaborative study on AVS in Japan (WAVES-J study). Data of 449patients (198men, 251women, mean age 54.3±11.1 y) from 9 centers with basal ARR>200 and at least one positive result of confirmatory testing, including the captopril challenge test, the upright furosemide-loading test and the saline loading test were studied. We divided the patients into the following 4 groups by the 3 hypothetical cut-off values of PAC, PAC≦100pg/ml (Low PAC group, n=54), PAC 100-120pg/ml (Normal PAC group, n=39), PAC 120-150pg/ml (High normal PAC group, n=81) and PAC>150pg/ml (High PAC group, n=275). We analyzed the rate of the unilateral disease in the 4 PAC groups by the 12 criteria, the LI>2, 3 or 4 with or without the unilateral CR<1, before or after ACTH stimulation.

Results: One hundred and one (29%, 101/354) patients were determined as the unilateral disease in AVS after ACTH stimulation. In the criterion of the LI>4, 3 (7.3%, 3/41) patients in Low PAC group, 2 (6.2%, 2/32) patients in Normal PAC group, 6 (9.1%, 6/66) patients in High normal group and 90 (41.9%, 90/215) patients in High PAC group had the unilateral disease in AVS after ACTH stimulation (p<0.05). Among the 3 hypothetical cut-off values of PAC, 100pg/ml, 120pg/ml and 150pg/ml, the percentages of detectable patients with the unilateral disease in AVS were not significantly different, 97.0%, 95.0% and 89.1% respectively (p>0.05). In contrast, percentages of the patients with basal PAC less than each cut-off value were significantly higher in the higher cut-off values of PAC, 12%, 21% and 39% respectively (p<0.05).

Conclusion: It is recommended that the cut-off value of basal PAC (not exceeding 150pg/ml) be adopted based on the clinical needs and the capacity for confirmatory tests and AVS in each center.

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