International multicenter survey on screening and confirmatory testing in primary aldosteronism
International multicenter survey on screening and confirmatory testing in primary aldosteronism
复制标题
原发性醛固酮增多症筛查和确证检测的国际多中心调查
DOI：
10.1093/ejendo/lvac002
复制
发表时间：
2023
影响因子：
5.8
通讯作者：
et al.
中科院分区：
文献类型：
--
作者：
Naruse Mitsuhide;Murakami Masanori;Katabami Takuyuki;Kocjan Tomaz;et al.
原发性醛固酮增多症（PA）是继发性高血压最常见的病因之一。虽然临床实践指南建议的诊断过程中，步骤的细节仍然不完全standardized.DesignIn目前的SCOT-PA调查，我们已经调查了不同的专家中心，通过使用谷歌问卷调查，每个诊断步骤所采用的方法的多样性。来自3大洲的33个中心participated.ResultsWe表现出显着的多样性，在血液采样的条件下，测定方法的醛固酮和肾素，和方法和诊断截止筛选和确证试验。最标准的措施是调整抗高血压药物和采血坐姿，通过化学发光酶免疫法测量血浆醛固酮浓度（PAC）和活性肾素浓度，结合醛固酮与肾素的比例和PAC作为筛选指标，并进行验证性测试的坐姿盐水输注试验。筛选和确证性测试的截止值显示centers.ConclusionsDiversity的诊断步骤之间的显着变化可能会导致PA的诊断中心之间的不一致和限制比较PA的证据不同的中心。我们预计这种多样性的影响在轻度PA患者中最为突出。该调查提出了2个问题：需要标准化的诊断过程和重新审视轻度PA的概念。诊断过程/标准的进一步标准化将提高证据质量和PA患者的管理。
ObjectivePrimary aldosteronism (PA) is one of the most frequent causes of secondary hypertension. Although clinical practice guidelines recommend a diagnostic process, details of the steps remain incompletely standardized.DesignIn the present SCOT-PA survey, we have investigated the diversity of approaches utilized for each diagnostic step in different expert centers through a survey using Google questionnaires. A total of 33 centers from 3 continents participated.ResultsWe demonstrated a prominent diversity in the conditions of blood sampling, assay methods for aldosterone and renin, and the methods and diagnostic cutoff for screening and confirmatory tests. The most standard measures were modification of antihypertensive medication and sitting posture for blood sampling, measurement of plasma aldosterone concentration (PAC) and active renin concentration by chemiluminescence enzyme immunoassay, a combination of aldosterone-to-renin ratio with PAC as an index for screening, and saline infusion test in a seated position for confirmatory testing. The cutoff values for screening and confirmatory testing showed significant variation among centers.ConclusionsDiversity of the diagnostic steps may lead to an inconsistent diagnosis of PA among centers and limit comparison of evidence for PA between different centers. We expect the impact of this diversity to be most prominent in patients with mild PA. The survey raises 2 issues: the need for standardization of the diagnostic process and revisiting the concept of mild PA. Further standardization of the diagnostic process/criteria will improve the quality of evidence and management of patients with PA.