• Chien-Wei Huang, Kun-Hua Tu, Kang-Chih Fan, Cheng-Hsuan Tsai, Wei-Ting Wang, Shu-Yi Wang, Chun-Yi Wu, Ya-Hui Hu, Shu-Heng Huang, Han-Wen Liu, Fen-Yu Tseng, Wan-Chen Wu, Chin-Chen Chang, Yen-Hung Lin, Vin-Cent Wu, and Chii-Min Hwu.
• Division of Nephrology, Department of Medicine, Kaohsiung Veterans General Hospital, National Yang Ming Chiao Tung University, School of Medicine, Taiwan; Institute of Clinical Medicine, College of Medicine, National Cheng Kung University, Tainan, Taiwan.
• J Formos Med Assoc. 2024 Mar 1; 123 Suppl 2: S104S113S104-S113.

AbstractConfirmatory tests for diagnosis of primary aldosteronism (PA) play an important role in sparing patients with a false-positive aldosterone-to-renin ratio (ARR) screening test from undergoing invasive subtyping procedures. We recommend that patients with a positive ARR test should undergo at least one confirmatory test to confirm or exclude the diagnosis of PA before directly proceeding to subtype studies, except for patients with significant PA phenotypes, including spontaneous hypokalemia, plasma aldosterone concentration >20 ng/dL plus plasma renin activity below a detectable level. Although a gold standard confirmatory test has not been identified, we recommend that saline infusion test and captopril challenge test, which were widely used in Taiwan. Patients with PA have been reported to have a higher prevalence of concurrent autonomous cortisol secretion (ACS). ACS is a biochemical condition of mild cortisol overproduction from adrenal lesions, but without the typical clinical features of overt Cushing's syndrome. Concurrent ACS may result in incorrect interpretation of adrenal venous sampling (AVS) and may lead to adrenal insufficiency after adrenalectomy. We recommend screening for ACS in patients with PA scheduled for AVS examinations as well as for adrenalectomy. We recommend the 1-mg overnight dexamethasone suppression test as screening method to detect ACS.Copyright © 2023 Formosan Medical Association. Published by Elsevier B.V. All rights reserved.

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