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Horm Metab Res 2010; 42(6): 406-410
DOI: 10.1055/s-0029-1246186
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© Georg Thieme Verlag KG Stuttgart · New York

Confirmatory Tests in the Diagnosis of Primary Aldosteronism

P. Mulatero1 , S. Monticone1 , C. Bertello1 , G. Mengozzi2 , D. Tizzani1 , A. Iannaccone1 , F. Veglio1
  • 1Division of Internal Medicine and Hypertension Unit, Department of Medicine and Experimental Oncology, University of Torino, Torino, Italy
  • 2Clinical Chemistry Laboratory, AOU San Giovanni Battista, Torino, Italy
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Publication History

received 29.09.2009

accepted 14.12.2009

Publication Date:
29 January 2010 (online)

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Abstract

Primary aldosteronism is the most common form of secondary hypertension and patients with hyperaldosteronism are more prone to premature cardiovascular complications compared to essential hypertensives. The diagnostic flow-chart for the diagnosis of PA is performed in three steps: a) screening; b) confirmation; and c) subtype differentiation. Instead of proceeding directly to subtype classification, the recently published Endocrine Society Guidelines recommend that patients with a positive ARR should undergo a confirmatory test, in order to definitively confirm or exclude the diagnosis of PA. The Guidelines recognize four testing procedures: oral sodium loading, saline infusion, fludrocortisone suppression, and captopril challenge. Herein we discuss the diagnostic protocols for these confirmatory tests and highlight both the advantages and contraindications and we discuss studies in which these confirmatory tests have been compared.

Key words

saline load - aldosterone - captopril test - fludrocortisone - hyperaldosteronism

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Correspondence

P. Mulatero

Medicina Interna 4 e Centro Ipertensione

AOU S. Giovanni Battista

Via Genova 3

10126 Torino

Italy

Phone: +39 011 6336959/20

Fax: +39 011 6336931

Email: paolo.mulatero@libero.it