This Article Full Text (PDF) Alert me when this article is cited Alert me if a correction is posted Citation Map Services Email this article to a friend Similar articles in this journal Similar articles in PubMed Alert me to new issues of the journal Download to citation manager Request Permissions Citing Articles Citing Articles via HighWire Citing Articles via Google Scholar Google Scholar Articles by Holland, O. B. Articles by Gomez-Sanchez, C. E. Search for Related Content PubMed PubMed Citation Articles by Holland, O. B. Articles by Gomez-Sanchez, C. E.

Hypertension, Vol 6, 717-723, Copyright © 1984 by American Heart Association

ARTICLES

Further evaluation of saline infusion for the diagnosis of primary aldosteronism

OB Holland, H Brown, L Kuhnert, C Fairchild, M Risk and CE Gomez-Sanchez

Normal subjects, normal-renin hypertensive patients, and low-renin hypertensive patients were evaluated by intravenous saline infusion and with a fludrocortisone acetate (Florinef) protocol to clarify diagnostic criteria for primary aldosteronism that are recommended for the saline infusion protocol. The patients consumed a 200 mEq sodium, 70 mEq potassium diet for 6 days, and on the last 3 days received Florinef 0.5 mg orally twice daily. On Days 3 and 6, urinary aldosterone and tetrahydroaldosterone excretions were determined, and on Days 4 and 7 plasma aldosterone (PA) was determined at 0600 after overnight recumbency and at 0800 after 2 hours of walking. Although the level of normal PA suppression by saline infusion has been commonly defined as 10 ng/dl, a value of 5 ng/dl was originally recommended. In 20 normal subjects and 45 normal-renin hypertensive patients, we found that the PA was almost always suppressed below 5 ng/dl. In 18 of 75 low- renin patients including five with aldosterone-producing adenoma (APA), the PA was never suppressed below 10 ng/dl; thus, these 18 patients had classical primary aldosteronism by generally accepted criteria. The Florinef protocol was performed in eight of these 18 patients and was abnormal in all. An abnormal Florinef protocol was also found in seven of 15 patients studied with PA suppression after saline infusion to between 5 and 10 ng/dl, but in only one of 24 patients studied with PA suppression below 5 ng/dl. Additional studies in the subgroup with abnormal results from the Florinef protocol indicated that none of these patients had evidence of APA, so they had nontumorous primary aldosteronism (NTPA).(ABSTRACT TRUNCATED AT 250 WORDS)

This article has been cited by other articles:

				J. W. Funder, R. M. Carey, C. Fardella, C. E. Gomez-Sanchez, F. Mantero, M. Stowasser, W. F. Young Jr., and V. M. Montori Case Detection, Diagnosis, and Treatment of Patients with Primary Aldosteronism: An Endocrine Society Clinical Practice Guideline J. Clin. Endocrinol. Metab., September 1, 2008; 93(9): 3266 - 3281. [Abstract] [Full Text] [PDF]

				M. L. Muiesan, M. Salvetti, A. Paini, C. Agabiti-Rosei, C. Monteduro, G. Galbassini, E. Belotti, C. Aggiusti, D. Rizzoni, M. Castellano, et al. Inappropriate Left Ventricular Mass in Patients With Primary Aldosteronism Hypertension, September 1, 2008; 52(3): 529 - 534. [Abstract] [Full Text] [PDF]

				G. P. Rossi, A. Belfiore, G. Bernini, G. Desideri, B. Fabris, C. Ferri, G. Giacchetti, C. Letizia, M. Maccario, F. Mallamaci, et al. Comparison of the Captopril and the Saline Infusion Test for Excluding Aldosterone-Producing Adenoma Hypertension, August 1, 2007; 50(2): 424 - 431. [Abstract] [Full Text] [PDF]

				C. Schirpenbach, L. Seiler, C. Maser-Gluth, F. Beuschlein, M. Reincke, and M. Bidlingmaier Automated Chemiluminescence-Immunoassay for Aldosterone during Dynamic Testing: Comparison to Radioimmunoassays with and without Extraction Steps Clin. Chem., September 1, 2006; 52(9): 1749 - 1755. [Abstract] [Full Text] [PDF]

				P. Mulatero, A. Milan, F. Fallo, G. Regolisti, F. Pizzolo, C. Fardella, L. Mosso, L. Marafetti, F. Veglio, and M. Maccario Comparison of Confirmatory Tests for the Diagnosis of Primary Aldosteronism J. Clin. Endocrinol. Metab., July 1, 2006; 91(7): 2618 - 2623. [Abstract] [Full Text] [PDF]

				C. Schirpenbach, L. Seiler, C. Maser-Gluth, F. Rudiger, C. Nickel, F. Beuschlein, and M. Reincke Confirmatory testing in normokalaemic primary aldosteronism: the value of the saline infusion test and urinary aldosterone metabolites. Eur. J. Endocrinol., June 1, 2006; 154(6): 865 - 873. [Abstract] [Full Text] [PDF]

				F. Fallo, F. Veglio, C. Bertello, N. Sonino, P. Della Mea, M. Ermani, F. Rabbia, G. Federspil, and P. Mulatero Prevalence and Characteristics of the Metabolic Syndrome in Primary Aldosteronism J. Clin. Endocrinol. Metab., February 1, 2006; 91(2): 454 - 459. [Abstract] [Full Text] [PDF]

				S.-C. Tiu, C.-H. Choi, C.-C. Shek, Y.-W. Ng, F. K. W. Chan, C.-M. Ng, and A. P. S. Kong The Use of Aldosterone-Renin Ratio as a Diagnostic Test for Primary Hyperaldosteronism and Its Test Characteristics under Different Conditions of Blood Sampling J. Clin. Endocrinol. Metab., January 1, 2005; 90(1): 72 - 78. [Abstract] [Full Text] [PDF]

				P. Mulatero, M. Stowasser, K.-C. Loh, C. E. Fardella, R. D. Gordon, L. Mosso, C. E. Gomez-Sanchez, F. Veglio, and W. F. Young Jr. Increased Diagnosis of Primary Aldosteronism, Including Surgically Correctable Forms, in Centers from Five Continents J. Clin. Endocrinol. Metab., March 1, 2004; 89(3): 1045 - 1050. [Abstract] [Full Text] [PDF]

				D. A. Calhoun, M. K. Nishizaka, M. A. Zaman, R. B. Thakkar, and P. Weissmann Hyperaldosteronism Among Black and White Subjects With Resistant Hypertension Hypertension, December 1, 2002; 40(6): 892 - 896. [Abstract] [Full Text] [PDF]

				P. Mulatero, F. Rabbia, A. Milan, C. Paglieri, F. Morello, L. Chiandussi, and F. Veglio Drug Effects on Aldosterone/Plasma Renin Activity Ratio in Primary Aldosteronism Hypertension, December 1, 2002; 40(6): 897 - 902. [Abstract] [Full Text] [PDF]

				P. Mulatero, T. A. Williams, A. Milan, C. Paglieri, F. Rabbia, F. Fallo, and F. Veglio Blood Pressure in Patients with Primary Aldosteronism Is Influenced by Bradykinin B2 Receptor and {alpha}-Adducin Gene Polymorphisms J. Clin. Endocrinol. Metab., July 1, 2002; 87(7): 3337 - 3343. [Abstract] [Full Text] [PDF]

				M. Stowasser, R. D Gordon, J. C Rutherford, N. Z Nikwan, N. Daunt, and G. J Slater Review: Diagnosis and management of primary aldosteronism Journal of Renin-Angiotensin-Aldosterone System, September 1, 2001; 2(3): 156 - 169. [PDF]

				J. L. Phillips, M. M. Walther, J. C. Pezzullo, W. Rayford, P. L. Choyke, A. A. Berman, W. M. Linehan, J. L. Doppman, and J. R. Gill Jr. Predictive Value of Preoperative Tests in Discriminating Bilateral Adrenal Hyperplasia from an Aldosterone-Producing Adrenal Adenoma J. Clin. Endocrinol. Metab., December 1, 2000; 85(12): 4526 - 4533. [Abstract] [Full Text]

				C. E Gomez-Sanchez Primary aldosteronism and its variants Cardiovasc Res, January 1, 1998; 37(1): 8 - 13. [Full Text] [PDF]