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The Saline Infusion Test for Primary Aldosteronism: Implications of Immunoassay Inaccuracy.
Eisenhofer, Graeme; Kurlbaum, Max; Peitzsch, Mirko; Constantinescu, Georgiana; Remde, Hanna; Schulze, Manuel; Kaden, Denise; Müller, Lisa Marie; Fuss, Carmina T; Kunz, Sonja; Kolodziejczyk-Kruk, Sylwia; Gruber, Sven; Prejbisz, Aleksander; Beuschlein, Felix; Williams, Tracy Ann; Reincke, Martin; Lenders, Jacques W M; Bidlingmaier, Martin.
Afiliación
  • Eisenhofer G; Department of Medicine III, University Hospital Carl Gustav Carus, Technische Universität Dresden, Dresden, Germany.
  • Kurlbaum M; Institute of Clinical Chemistry and Laboratory Medicine, University Hospital Carl Gustav Carus, Technische Universität Dresden, Dresden, Germany.
  • Peitzsch M; Department of Internal Medicine I, Division of Endocrinology and Diabetes, University Hospital, University of Würzburg, Würzburg, Germany.
  • Constantinescu G; Institute of Clinical Chemistry and Laboratory Medicine, University Hospital Carl Gustav Carus, Technische Universität Dresden, Dresden, Germany.
  • Remde H; Department of Medicine III, University Hospital Carl Gustav Carus, Technische Universität Dresden, Dresden, Germany.
  • Schulze M; Department of Internal Medicine I, Division of Endocrinology and Diabetes, University Hospital, University of Würzburg, Würzburg, Germany.
  • Kaden D; Center for Information Services and High Performance Computing, Technische Universität Dresden, Dresden, Germany.
  • Müller LM; Institute of Clinical Chemistry and Laboratory Medicine, University Hospital Carl Gustav Carus, Technische Universität Dresden, Dresden, Germany.
  • Fuss CT; Department of Medicine IV, University Hospital, Ludwig Maximilian University Munich, Munich, Germany.
  • Kunz S; Department of Internal Medicine I, Division of Endocrinology and Diabetes, University Hospital, University of Würzburg, Würzburg, Germany.
  • Kolodziejczyk-Kruk S; Department of Medicine IV, University Hospital, Ludwig Maximilian University Munich, Munich, Germany.
  • Gruber S; Department of Hypertension, National Institute of Cardiology, Warsaw, Poland.
  • Prejbisz A; Department of Endocrinology, Diabetology and Clinical Nutrition, University Hospital Zurich (USZ) and University of Zurich (UZH), Zurich, Switzerland.
  • Beuschlein F; Department of Hypertension, National Institute of Cardiology, Warsaw, Poland.
  • Williams TA; Department of Medicine IV, University Hospital, Ludwig Maximilian University Munich, Munich, Germany.
  • Reincke M; Department of Endocrinology, Diabetology and Clinical Nutrition, University Hospital Zurich (USZ) and University of Zurich (UZH), Zurich, Switzerland.
  • Lenders JWM; Department of Medicine IV, University Hospital, Ludwig Maximilian University Munich, Munich, Germany.
  • Bidlingmaier M; Division of Internal Medicine and Hypertension, Department of Medical Sciences, University of Turin, Turin, Italy.
J Clin Endocrinol Metab ; 107(5): e2027-e2036, 2022 04 19.
Article en En | MEDLINE | ID: mdl-34963138
CONTEXT: Diagnosis of primary aldosteronism (PA) for many patients depends on positive results for the saline infusion test (SIT). Plasma aldosterone is often measured by immunoassays, which can return inaccurate results. OBJECTIVE: This study aimed to establish whether differences in aldosterone measurements by immunoassay versus mass spectrometry (MS) might impact confirmatory testing for PA. METHODS: This study, involving 240 patients tested using the SIT at 5 tertiary care centers, assessed discordance between immunoassay and MS-based measurements of plasma aldosterone. RESULTS: Plasma aldosterone measured by Liaison and iSYS immunoassays were respectively 86% and 58% higher than determined by MS. With an immunoassay-based SIT cutoff for aldosterone of 170 pmol/L, 78 and 162 patients had, respectivel, negative and positive results. All former patients had MS-based measurements of aldosterone < 117 pmol/L, below MS-based cutoffs of 162 pmol/L. Among the 162 patients with pathogenic SIT results, MS returned nonpathologic results in 62, including 32 under 117 pmol/L. Repeat measurements by an independent MS method confirmed nonpathogenic results in 53 patients with discordant results. Patients with discordant results showed a higher (P < 0.0001) prevalence of nonlateralized than lateralized adrenal aldosterone production than patients with concordant results (83% vs 28%). Among patients with nonlateralized aldosterone production, 66% had discordant results. Discordance was more prevalent for the Liaison than iSYS immunoassay (32% vs 16%; P = 0.0065) and was eliminated by plasma purification to remove interferents. CONCLUSION: These findings raise concerns about the validity of immunoassay-based diagnosis of PA in over 60% of patients with presumed bilateral disease. We provide a simple solution to minimize immunoassay inaccuracy-associated misdiagnosis of PA.
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Texto completo: 1 Banco de datos: MEDLINE Asunto principal: Aldosterona / Hiperaldosteronismo Tipo de estudio: Diagnostic_studies / Risk_factors_studies Límite: Humans Idioma: En Revista: J Clin Endocrinol Metab Año: 2022 Tipo del documento: Article País de afiliación: Alemania

Texto completo: 1 Banco de datos: MEDLINE Asunto principal: Aldosterona / Hiperaldosteronismo Tipo de estudio: Diagnostic_studies / Risk_factors_studies Límite: Humans Idioma: En Revista: J Clin Endocrinol Metab Año: 2022 Tipo del documento: Article País de afiliación: Alemania