Document Detail

A reverse postural test as a screening tool for aldosterone-producing adenoma: a pilot study.
MedLine Citation:
PMID:  19399649     Owner:  NLM     Status:  MEDLINE    
The aldosterone-to-renin ratio (ARR) is an accepted screening tool for primary hyperaldosteronism (PA). An ambulatory case finding test to separate surgically remediable aldosterone-producing adenoma (APA) from other forms of PA, however, is currently not available. The aim of this study was to evaluate a reverse postural test (RPT) as a novel tool for identifying APA. We investigated 6 healthy controls, 19 primary hypertensive patients, and a prospective cohort of 32 patients clinically suspicious for primary hyperaldosteronism. We diagnosed seven patients with surgically proven APA, and three patients with idiopathic hyperaldosteronism. Serum aldosterone was measured after 30-min of moderate exercise (Aldo-1) and after a subsequent 2-h supine resting period (Aldo-2) with calculation of the ratio Aldo-2/Aldo-1. Aldosterone significantly decreased after supine resting in both healthy controls and primary hypertensives, but not in patients with APA. Receiver-operating-curve analysis revealed that the RPT was suitable for the screening of APA. A combination of the ratio Aldo-2/Aldo-1 >0.59 and Aldo-2 >160 pg/ml correctly identified all the patients with APA, with no false positives. Although the high sensitivity of the RPT here observed needs to be confirmed in larger studies, the high positive predictive value of RPT could be useful for the identification of APA in outpatients.
Martin O Weickert; Beate Sch?fl-Siegert; Ayman M Arafat; Andreas F H Pfeiffer; Matthias M?hlig; Christof Sch?fl
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Publication Detail:
Type:  Controlled Clinical Trial; Journal Article     Date:  2009-04-28
Journal Detail:
Title:  Endocrine     Volume:  36     ISSN:  1355-008X     ISO Abbreviation:  Endocrine     Publication Date:  2009 Aug 
Date Detail:
Created Date:  2009-07-07     Completed Date:  2009-10-01     Revised Date:  2010-06-24    
Medline Journal Info:
Nlm Unique ID:  9434444     Medline TA:  Endocrine     Country:  United States    
Other Details:
Languages:  eng     Pagination:  75-82     Citation Subset:  IM    
Department of Endocrinology, Charit?-University Medicine Berlin, Campus Benjamin Franklin, Berlin, Germany.
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MeSH Terms
Adenoma / complications,  diagnosis*
Adrenal Gland Neoplasms / complications,  diagnosis*
Aldosterone / blood
Diagnosis, Differential
Hydrocortisone / blood
Hyperaldosteronism / diagnosis*,  etiology
Hypertension / complications
Mass Screening / methods*
Middle Aged
Pilot Projects
Predictive Value of Tests
Prospective Studies
Renin / blood
Sensitivity and Specificity
Supine Position
Reg. No./Substance:
50-23-7/Hydrocortisone; 52-39-1/Aldosterone; EC

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