ArticleThe Journal of clinical endocrinology and metabolism2022
The Saline Infusion Test for Primary Aldosteronism: Implications of Immunoassay Inaccuracy.
Article in The Journal of clinical endocrinology and metabolism, 2022. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 29 papers.
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Who cites it
29 citing papers in PubMed, 81 citations in OpenAlex.
- Apparent Bilateral Aldosterone Suppression During Adrenal Vein Sampling: An Artefact of the Liaison Chemiluminescence Immunoassay and Other Causes Revealed by Comparisons With Another Commercial Immunoassay and Mass Spectrometry.Clinical endocrinology · 2026Observational
- Is It Time to Retire Aldosterone Suppression Testing?American journal of hypertension · 2026Review
- Article
- Incidence of Adrenal Masses Eventually Discovered in Patients Screened for Primary Aldosteronism.The Journal of clinical endocrinology and metabolism · 2026Article
- Mass Spectrometric Measurements of 11-Deoxycortisol, Androstenedione and Dehydroepiandrosterone Are Superior to Cortisol to Assess Selectivity of Non-Stimulated Adrenal Vein Sampling.Clinical endocrinology · 2026Article
- The Role of Aldosterone in Detecting Resistance-Driven Hypoaldosteronism and Deficit-Driven Hypoaldosteronism.Journal of clinical medicine · 2025Article
- Overnight Dexamethasone in Primary Aldosteronism Screening in Patients on Interfering Therapy (ODEPRASC): A Diagnostic Interpretability Study Protocol.Journal of clinical hypertension (Greenwich, Conn.) · 2025Article
- Comparisons of renin-angiotensin-aldosterone levels measured by chemical luminescence immunoassay and liquid chromatography-tandem mass spectrometry in hypertensive patients under different pathophysiological conditions.Journal of human hypertension · 2025Article
- Robustness of steroidomics-based machine learning for diagnosis of primary aldosteronism: a laboratory medicine perspective.Clinical chemistry and laboratory medicine · 2025Article
- Validation of a new non-invasive predictive score (KASAI) for primary aldosteronism subtyping.Endocrine connections · 2025Article
- Characterizing the Origins of Primary Aldosteronism.Hypertension (Dallas, Tex. : 1979) · 2025Article
- The Spectrum of Dysregulated Aldosterone Production: An International Human Physiology Study.The Journal of clinical endocrinology and metabolism · 2024Article
- Saline suppression testing-induced hypocalcemia and implications for clinical interpretations.European journal of endocrinology · 2024Article
- Diagnostic Accuracy of Aldosterone and Renin Measurement by Chemiluminescence for Screening of Patients with Primary Aldosteronism.International journal of molecular sciences · 2024Article
- Challenges in Diagnosing and Managing the Spectrum of Primary Aldosteronism.Journal of the Endocrine Society · 2024Article
- Investigating the cut-off values of captopril challenge test for primary aldosteronism using the novel chemiluminescent enzyme immunoassay method: a retrospective cohort study.Hypertension research : official journal of the Japanese Society of Hypertension · 2024Article
- Screening Cutoff Values for the Detection of Aldosterone-Producing Adenoma by LC-MS/MS and a Novel Noncompetitive CLEIA.Journal of the Endocrine Society · 2024Article
- Association of adrenal steroids with metabolomic profiles in patients with primary and endocrine hypertension.Frontiers in endocrinology · 2024Article
- Impact of confirmatory test results on subtype classification and biochemical outcome following unilateral adrenalectomy in patients with primary aldosteronism.Frontiers in endocrinology · 2024Article
- Efficacy of Oral Furosemide Test for Primary Aldosteronism Diagnosis.Journal of the Endocrine Society · 2023Article
Corrections and comments
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Authors and funding
18 authors at 8 institutions in 5 countries.
Funding
Abstract
contextDiagnosis 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.
objectiveThis study aimed to establish whether differences in aldosterone measurements by immunoassay versus mass spectrometry (MS) might impact confirmatory testing for PA.
methodsThis study, involving 240 patients tested using the SIT at 5 tertiary care centers, assessed discordance between immunoassay and MS-based measurements of plasma aldosterone.
resultsPlasma 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.
conclusionThese 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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