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Liu X, Guo C, Bian J, Hao S, Lou Y, Zhang H, Zhou X, Cai J, Ma W. Captopril challenge test in the diagnosis of primary aldosteronism: consistency between 1- and 2- h sampling. Front Endocrinol (Lausanne) 2023; 14:1183161. [PMID: 37378020 PMCID: PMC10291613 DOI: 10.3389/fendo.2023.1183161] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/09/2023] [Accepted: 05/25/2023] [Indexed: 06/29/2023] Open
Abstract
Objective To examine the consistency of plasma aldosterone concentration at 1 and 2 h in the captopril challenge test (CCT) and to explore the possibility of replacing 2-h aldosterone concentration with 1-h aldosterone concentration for diagnosis of primary aldosteronism (PA). Methods This retrospective analysis included a total of 204 hypertensive patients suspected of having PA. Subjects received oral captopril challenge at 50 mg (25 mg if the systolic blood pressure was <120 mmHg), and plasma aldosterone concentration and direct renin concentration were measured at 1 and 2 h afterward (chemiluminescence immunoassay Liaison® DiaSorin, Italy). Sensitivity and specificity were used to reflect the diagnostic performance of 1-h aldosterone concentration using 2-h aldosterone concentration (11 ng/dl as the cutoff) as the reference. A receiver operating characteristic curve analysis was also conducted. Results Among the 204 included patients [median age of 57.0 (48.0-61.0) years, 54.4% men], a diagnosis of PA was established in 94 patients. Aldosterone concentration in the patients with essential hypertension was 8.40 (interquartile range 7.05-11.00) ng/dl at 1 h and 7.65 (5.98-9.30) ng/dl at 2 h (P < 0.001). In patients with PA, aldosterone concentration was 16.80 (12.58-20.50) ng/dl at 1 h and 15.55 (12.60-20.85) ng/dl at 2 h (P > 0.999). At a cutoff of 11 ng/dl, the sensitivity and specificity of using 1-h aldosterone concentration to diagnose PA were 87.2% and 78.2%, respectively. A higher cutoff of 12.5 ng/ml increased specificity to 90.0% but decreased sensitivity to 75.5%. A lower cutoff of 9.3 ng/ml increased sensitivity to 97.9% but decreased specificity to 65.4%. Conclusions When diagnosing PA with CCT, 1-h aldosterone concentration could not be used to replace 2-h aldosterone concentration.
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Tamura N, Watanabe E, Shirakawa R, Nakatani E, Yamada K, Hatakeyama H, Torii-Hanakita M, Kyo C, Kosugi R, Ogawa T, Kotani M, Usui T, Inoue T. Comparisons of plasma aldosterone and renin data between an automated chemiluminescent immunoanalyzer and conventional radioimmunoassays in the screening and diagnosis of primary aldosteronism. PLoS One 2021; 16:e0253807. [PMID: 34242264 PMCID: PMC8270132 DOI: 10.1371/journal.pone.0253807] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/21/2021] [Accepted: 06/13/2021] [Indexed: 11/18/2022] Open
Abstract
Determining values of plasma renin activity (PRA) or plasma active renin concentration (ARC), plasma aldosterone concentration (PAC), and aldosterone-to-renin ratio (ARR) is essential to diagnose primary aldosteronism (PA), but it takes several days with conventional radioimmunoassays (RIAs). Chemiluminescent enzyme immunoassays for PAC and ARC using the Accuraseed® immunoanalyzer facilitated the determination, but relations between Accuraseed® immunoanalyzer-based and RIA-based values in samples of PA confirmatory tests and adrenal venous sampling remained to be elucidated. We addressed this issue in the present study. This is a prospective, cross-sectional study. ARC and PAC values were measured by the Accuraseed® immunoanalyzer in samples, in which PRA and PAC values had been measured by the PRA-FR® RIA and SPAC®-S Aldosterone kits, respectively. The relations between Accuraseed® immunoanalyzer-based and RIA-based values were investigated with regression analyses. The optimal cutoff of Accuraseed® immunoanalyzer-based ARR for PA screening was determined by the receiver operating characteristic analysis. After log-log transformations, linear relations with high coefficients of determination were observed between Accuraseed® immunoanalyzer-based and RIA-based data of renin and aldosterone. Following the PA guidelines of Japan Endocrine Society, Accuraseed® immunoanalyzer-based cutoffs were calculated from the regression equations: the basal PAC for PA screening >12 ng/dL, PAC for the saline infusion test >8.2 ng/dL, ARC for the furosemide-upright test <15 pg/mL, and ARR for the captopril challenge test >3.09 ng/dL per pg/mL. The optimal cutoff of Accuraseed® immunoanalyzer-based ARR for PA screening was >2.43 ng/dL over pg/mL not to overlook bilateral PA patients. The present study provided conversion formulas between Accuraseed® immunoanalyzer-based and RIA-based values of renin, aldosterone, and ARR, not only in basal samples but also in samples of PA confirmatory tests and adrenal venous sampling. Although validation studies are awaited, the present study will become priming water of harmonization of renin and aldosterone immunoassays.
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Affiliation(s)
- Naohisa Tamura
- Research Support Center, Shizuoka General Hospital, Shizuoka, Shizuoka, Japan
- Center for Diabetes, Endocrinology and Metabolism, Shizuoka General Hospital, Shizuoka, Shizuoka, Japan
- * E-mail:
| | - Erika Watanabe
- Department of Clinical Laboratory Medicine, Shizuoka General Hospital, Shizuoka, Shizuoka, Japan
| | - Rumi Shirakawa
- Department of Clinical Laboratory Medicine, Shizuoka General Hospital, Shizuoka, Shizuoka, Japan
| | - Eiji Nakatani
- Research Support Center, Shizuoka General Hospital, Shizuoka, Shizuoka, Japan
| | - Kanako Yamada
- Center for Diabetes, Endocrinology and Metabolism, Shizuoka General Hospital, Shizuoka, Shizuoka, Japan
| | - Hiroshi Hatakeyama
- Center for Diabetes, Endocrinology and Metabolism, Shizuoka General Hospital, Shizuoka, Shizuoka, Japan
| | - Mizuki Torii-Hanakita
- Center for Diabetes, Endocrinology and Metabolism, Shizuoka General Hospital, Shizuoka, Shizuoka, Japan
| | - Chika Kyo
- Center for Diabetes, Endocrinology and Metabolism, Shizuoka General Hospital, Shizuoka, Shizuoka, Japan
| | - Rieko Kosugi
- Center for Diabetes, Endocrinology and Metabolism, Shizuoka General Hospital, Shizuoka, Shizuoka, Japan
- Department of Medical Genetics, Shizuoka General Hospital, Shizuoka, Shizuoka, Japan
| | - Tatsuo Ogawa
- Center for Diabetes, Endocrinology and Metabolism, Shizuoka General Hospital, Shizuoka, Shizuoka, Japan
| | - Masato Kotani
- Center for Diabetes, Endocrinology and Metabolism, Shizuoka General Hospital, Shizuoka, Shizuoka, Japan
| | - Takeshi Usui
- Research Support Center, Shizuoka General Hospital, Shizuoka, Shizuoka, Japan
- Department of Medical Genetics, Shizuoka General Hospital, Shizuoka, Shizuoka, Japan
| | - Tatsuhide Inoue
- Center for Diabetes, Endocrinology and Metabolism, Shizuoka General Hospital, Shizuoka, Shizuoka, Japan
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