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Horm Metab Res 2012; 44(07): 527-532
DOI: 10.1055/s-0032-1314786
Humans, Clinical
© Georg Thieme Verlag KG Stuttgart · New York

Comparison of the Saline Infusion Test and the Fludrocortisone Suppression Test for the Diagnosis of Primary Aldosteronism

H. S. Willenberg
1   Department of Endocrinology, Diabetes and Rheumatology, Medical Faculty, Heinrich-Heine University Düsseldorf, Düsseldorf, Germany
2   Department of Medicine III, Technical University Dresden, Dresden, Germany
,
O. Vonend
3   Department of Nephrology, Medical Faculty, Heinrich-Heine University Düsseldorf, Düsseldorf, Germany
,
M. Schott
1   Department of Endocrinology, Diabetes and Rheumatology, Medical Faculty, Heinrich-Heine University Düsseldorf, Düsseldorf, Germany
,
X. Gao
3   Department of Nephrology, Medical Faculty, Heinrich-Heine University Düsseldorf, Düsseldorf, Germany
,
D. Blondin
4   Institute for Diagnostic and Interventional Radiology, Medical Faculty, Heinrich-Heine University Düsseldorf, Düsseldorf, Germany
,
A. Saleh
4   Institute for Diagnostic and Interventional Radiology, Medical Faculty, Heinrich-Heine University Düsseldorf, Düsseldorf, Germany
,
L. C. Rump
3   Department of Nephrology, Medical Faculty, Heinrich-Heine University Düsseldorf, Düsseldorf, Germany
,
W. A. Scherbaum
1   Department of Endocrinology, Diabetes and Rheumatology, Medical Faculty, Heinrich-Heine University Düsseldorf, Düsseldorf, Germany
› Author Affiliations
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Publication History

received 26 October 2011

accepted 26 April 2012

Publication Date:
11 June 2012 (online)

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Abstract

For the diagnosis of primary aldosteronism (PA), confirmatory testing is mandatory and different function tests can be employed. There are, however, sparse data comparing the fludrocortisone suppression test (FST) and the saline infusion test (SIT). Patients with PA (n=90) or essential hypertension (n=65) were studied. They underwent one or the other test or both of them. Using the DPC Siemens aldosterone radioimmunoassay, we found that the SIT led to a stronger suppression of aldosterone than the FST. Post-test aldosterone-to-renin ratios (ARRs) and the percentage of suppression of aldosterone serum concentrations performed worse. The same results were observed in patients who underwent both FST and SIT. Some patients had divergent results in both tests. For the SIT, a lower cutoff value should be used than for the FST for the adequate identification of patients with unilateral PA. Long-term prospective studies are needed to address the question at what cutoff values patients benefit from subtype differentiation of PA. We discuss here possible explanations for divergent results obtained with both tests.

Key words

aldosterone - adrenal - fludrocortisones - hypertension
 

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