Dr Jun Yang is the senior author and Dr Hikaru Hashimura is the first author
Patients with primary aldosteronism (or PA, hypertension caused by too much aldosterone) need to have a salt water infusion test to confirm their diagnosis of PA. They then need adrenal vein sampling, whereby blood is collected from the adrenal glands above the kidneys, to work out if the excess aldosterone is from one or both adrenal glands. One affected gland can be surgically removed while two affected glands need to be treated with specific aldosterone-blockers. According to current guidelines, everyone with a diagnosis of PA needs adrenal vein sampling. However, the sampling procedure is difficult and time-consuming. Our study found that for a large proportion of patients, you can reliably predict that they have disease affecting both adrenal glands just by looking at the salt water infusion test. Such patients may skip the adrenal vein sampling procedure and go straight to medical treatment for their primary aldosteronism.
Centre for Endocrinology and Metabolism
Journal and article title
In our practice, we have always observed that certain patients are more likely to have bilateral adrenal disease based on their salt infusion test. However, there hasn't been a good formula to reliably predict who will have bilateral disease and can therefore skip adrenal vein sampling. Our formula, based on the salt infusion test, can predict bilateral disease with 96 per cent certainty.
Allowing patients to bypass adrenal vein sampling will benefit :
- the patient, due to reduced time in hospital and faster initiation of treatment
- the radiology department, due to more free time for other procedures
- the hospital / healthcare budget, due to reduced expenditure on adrenal vein sampling
Hypertension, primary aldosteronism