International multicenter survey on screening and confirmatory testing in primary aldosteronism

Naruse M 1 , Murakami M 2 , Katabami T 3 , Kocjan T 4 , Parasiliti-Caprino M 5 , Quinkler M 6 Show all authors , St-Jean M 7 , O'Toole S 8 , Ceccato F 9 , Kraljevic I 10 , Kastelan D 10 , Tsuiki M 11 , Deinum J 12 , Torre EM 13 , Puar T 14 , Markou A 15 , Piaditis G 15 , Laycock K 16 , Wada N 17 , Grytaas MA 18 , Kobayashi H 19 , Tanabe A 20 , Tong CV 21 , Gallego NV 22 , Gruber S 23 , Beuschlein F 23 , Kürzinger L 24 , Sukor N 25 , Azizan EABA 25 , Ragnarsson O 26 , Nijhoff MF 27 , Maiolino G 28 , Dalmazi GD 29 , Kalugina V 30 , Lacroix A 31 , Furnica RM 32 , Suzuki T 33

Affiliations 

  • 1 Endocrine Center and Clinical Research Center, Ijinkai Takeda General Hospital, Kyoto, 601-1495, Japan
  • 2 Department of Molecular Endocrinology and Metabolism, Tokyo Medical and Dental University, Tokyo, 113-8510, Japan
  • 3 Division of Metabolism and Endocrinology, Department of Internal Medicine, St. Marianna University Yokohama City Seibu Hospital, Yokohama, 241-0811, Japan
  • 4 Department of Endocrinology, Diabetes, and Metabolic Diseases, University Medical Centre Ljubljana, Ljubljana, 1000, Slovenia
  • 5 Endocrinology, Diabetes, and Metabolism; Department of Medical Sciences; University of Turin, Turin, 10126, Italy
  • 6 Endocrinology in Charlottenburg, Berlin, 10117, Germany
  • 7 Division of Endocrinology, Department of Medicine, Centre intégré universitaire de santé et de services sociaux de l'Estrie - Centre hospitalier Universitaire de Sherbrooke, Sherbrooke, Quebec, J1H 5N4, Canada
  • 8 Department of Endocrinology, The Royal Hallamshire Hospital, Sheffield, S10 2JF, UK
  • 9 Endocrinology Unit, Department of Medicine DIMED, University of Padova, Padova, 35128, Italy
  • 10 Department of Endocrinology, University Hospital Centre Zagreb, Zagreb, 10 000, Croatia
  • 11 Department of Endocrinology and Metabolism, NHO Kyoto Medical Center, Kyoto, 612-8555, Japan
  • 12 Department of Internal Medicine, Radboud University Medical Center, Nijmegen, 6525 GA, Netherlands
  • 13 Servicio de Endocrinología, Hospital Universitario Central de Asturias, Oviedo, 33011, Spain
  • 14 Department of Endocrinology, Changi General Hospital, Singapore, 529889, Singapore
  • 15 Endocrinology Department and Diabetes Center, 'G. Gennimatas' General Hospital of Athens, Athens, 115 28, Greece
  • 16 Department of Diabetes & Metabolism, Barts Health NHS Trust, St Bartholomew's and Royal London Hospital, London, E1 1BB, UK
  • 17 Department of Diabetes and Endocrinology, Sapporo City General Hospital, Sapporo, 060-8604, Japan
  • 18 Department of Medicine, Haukeland University Hospital, Bergen, 5021, Norway
  • 19 Division of Nephrology, Hypertension, and Endocrinology, Department of Internal Medicine, Nihon University School of Medicine, Tokyo, 173-8610, Japan
  • 20 Department of Diabetes, Endocrinology, and Metabolism, National Center for Global Health and Medicine, Tokyo, 162-8655, Japan
  • 21 Department of Medicine, Hospital Melaka, Melaka, 75400, Malaysia
  • 22 Department of Internal Medicine, Section of Endocrinology and Nutrition, Hospital Universitario de Cabueñes, Gijón, 33394, Spain
  • 23 Department of Endocrinology, Diabetology and Clinical Nutrition, Clinic for Endocrinology and Diabetology, University Hospital Zurich, CH-8091, Switzerland
  • 24 Department of Internal Medicine, Division of Endocrinology and Diabetes, University Hospital Würzburg, Würzburg, 97082, Germany
  • 25 Department of Medicine, The National University of Malaysia (UKM) Medical Centre, Kuala Lumpur, 59200, Malaysia
  • 26 Department of Endocrinology, Sahlgrenska University Hospital, Göteborg,413 45, Sweden
  • 27 Department of Internal Medicine, Division of Endocrinology and Diabetes, Leiden University Medical Center, Leiden, 2333 ZA, The Netherlands
  • 28 Clinica Medica 3, Department of Medicine - DIMED, University of Padova, Padova, 35126, Italy
  • 29 Unit of Endocrinology and Diabetes Prevention and Care, University of Bologna, Bologna, 40126, Italy
  • 30 Endocrinology Department, North-Western State Medical University named after I.I. Mechnikov, St Petersburg, 191015, Russia
  • 31 Endocrine Division, Department of Medicine, Centre hospitalier de l'Université de Montréal (CHUM), Montréal, H2X 3E4, Canada
  • 32 Department of Endocrinologie, Cliniques Universitaires Saint Luc, Bruxelles, 1200, Belgium
  • 33 Department of Public Health, International University of Health and Welfare School of Medicine, Chiba, 286-8686, Japan
Eur J Endocrinol, 2023 Jan 10;188(1).
PMID: 36726325 DOI: 10.1093/ejendo/lvac002

Abstract

OBJECTIVE: Primary aldosteronism (PA) is one of the most frequent causes of secondary hypertension. Although clinical practice guidelines recommend a diagnostic process, details of the steps remain incompletely standardized.

DESIGN: In the present SCOT-PA survey, we have investigated the diversity of approaches utilized for each diagnostic step in different expert centers through a survey using Google questionnaires. A total of 33 centers from 3 continents participated.

RESULTS: We demonstrated a prominent diversity in the conditions of blood sampling, assay methods for aldosterone and renin, and the methods and diagnostic cutoff for screening and confirmatory tests. The most standard measures were modification of antihypertensive medication and sitting posture for blood sampling, measurement of plasma aldosterone concentration (PAC) and active renin concentration by chemiluminescence enzyme immunoassay, a combination of aldosterone-to-renin ratio with PAC as an index for screening, and saline infusion test in a seated position for confirmatory testing. The cutoff values for screening and confirmatory testing showed significant variation among centers.

CONCLUSIONS: Diversity of the diagnostic steps may lead to an inconsistent diagnosis of PA among centers and limit comparison of evidence for PA between different centers. We expect the impact of this diversity to be most prominent in patients with mild PA. The survey raises 2 issues: the need for standardization of the diagnostic process and revisiting the concept of mild PA. Further standardization of the diagnostic process/criteria will improve the quality of evidence and management of patients with PA.

* Title and MeSH Headings from MEDLINE®/PubMed®, a database of the U.S. National Library of Medicine.

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