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Journal of Peking University (Health Sciences) ›› 2021, Vol. 53 ›› Issue (6): 1128-1132. doi: 10.19723/j.issn.1671-167X.2021.06.020

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Clinical value of captopril test in noninvasive diagnosis of aldosterone-producing adenoma

DONG Bo*,MA Xiao-wei(),GUO Xiao-hui,GAO Ying,ZHANG Jun-qing   

  1. Department of Endocrinology, Peking University First Hospital, Beijing 100034, China
  • Received:2019-10-15 Online:2021-12-18 Published:2021-12-13
  • Contact: Xiao-wei MA E-mail:xiaowei.ma@pkufh.com

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Abstract:

Objective: To analyze the clinical characteristics of aldosterone-producing adenoma (APA) subtypes in primary aldosteronism (PA) and the application value of captopril challenge test (CCT) in adenomas. And to find out the clinically specific non-invasive index for identifying APA subtypes from PA. Methods: The clinical data of hospitalized patients with hypertension were retrospectively collected. All the patients were conducted with the CCT and 90 patients with PA were confirmed. Among them, 34 patients were confirmed to have APA by surgery. The clinical indicators of the two groups of patients including plasma aldosterone concentration (PAC), aldosterone inhibition rate (%), and aldosterone to renin ratio (ARR) before and after the CCT were compared, the receiver operating characteristic (ROC) curves for the relevant indicators before and after the CCT drawn, and the areas under the curve (AUC) compared. The ROC curves were used to analyze the efficiency of the different CCT diagnostic criteria for diagnosing APA. Results: Compared with the PA group, the duration of hypertension was shorter, the incidence of hypokalemia was higher, and the average serum potassium level was lower when APA was diagnosed. There were no significant differences in blood pressure level, gender, serum sodium and body mass index between the two groups. Compared with PA population, APA group had higher PAC and ARR whether before or after the CCT, but lower plasma renin concentration (PRC). In APA patients, the mean degree of PAC declined after CCT was approximately 5.7%, but 5% with that of PA. As for diagnosing, ARR before or after CCT had diagnostic value for APA, in which the ARR cut-off point was 7.12, which yielded a sensitivity and specificity of 35.85% and 77.78%. The cut-off point of ARR after CCT was 4.23, with a sensitivity of 71.43% and specificity of 62.22%. For the diagnosis, the ARR before and after CCT were of no significant difference. However, the diagnostic specificity of ARR>7.12 combined with hypokalemia was up to 80%. Conclusion: ARR before or after CCT have clinical value for the diagnosis of APA from PA, when combined with hypokalemia yielded high specificity.

Key words: Hyperaldosteronism, Adrenocortical adenoma, Captopril

CLC Number: 

  • R586

Table 1

General characteristics of patients with APA or PA"

Items APA (n=34) PA (n=90) P
Male, n(%) 22 (64.7) 49 (54.4) 0.332
BMI/(kg/m2), $\overline{x}$±s 25.64±3.92 25.78±3.83 0.495
Age/years, $\overline{x}$±s 46.17±12.80 52.53±12.80 0.035
Hypertension history/years, M(P25,P75) 4.0 (1.0, 10.0) 10 (3, 18) 0.001
SBP/mmHg, $\overline{x}$±s 149.68±13.10 145.12±31.03 0.317
DBP/mmHg, $\overline{x}$±s 96.69±10.96 91.97±11.00 0.774
TC/(mmol/L), $\overline{x}$±s 4.03±0.80 4.19±0.97 0.542
TG/(mmol/L), $\overline{x}$±s 1.76±1.16 1.71±0.32 0.997
LDL-c/(mmol/L), $\overline{x}$±s 2.58±0.66 2.48±0.64 0.535
HDL-c/(mmol/L), $\overline{x}$±s 1.12±0.25 1.07±0.26 0.760
Serum potassium/(mmol/L), $\overline{x}$±s 3.13±0.74 3.30±0.51 0.040
Prevalence of hypokalemia, n(%) 32 (94.1) 56 (62.2) 0.001
Serum K+/(mmol/L), $\overline{x}$±s 2.83±0.28 2.96±0.28 0.180
Serum sodium/(mmol/L), $\overline{x}$±s 141.56±2.60 140.61±2.49 0.184
Glucose/(mmol/L), $\overline{x}$±s 5.58±0.90 6.07±2.16 0.178

Table 2

Concentration of aldosterone, renin between group APA and PA"

Items APA (n=34) PA (n=90) P
Before CCT
PAC/(ng/L) 296.0 (198.0, 389.0) 238.0 (191.0, 345.0) 0.036
PRC/(mU/L) 2.60 (1.60, 6.00) 3.60 (1.77, 7.77) 0.048
ARR 8.73 (5.53, 25.4) 6.28 (4.07, 13.75) 0.003
After CCT
PAC/(ng/L) 227.0 (173.0, 458.8) 203.0 (152.0, 307.0) 0.039
PRC/(mU/L) 3.60 (1.90, 8.50) 5.35 (2.35, 11.53) 0.035
ARR 5.97 (3.18, 12.86) 3.78 (2.38, 8.50) 0.004
Aldosterone inhibition rate*/% 5.7 (0, 21.3) 5.0 (0, 19.0) <0.001

Figure 1

ROC curve for ARR (1A) and PAC (1B) before CCT ARR, aldosterone to renin ratio; CCT, captopril challenge test; PAC, plasma aldosterone concentration."

Figure 2

ROC curve for ARR (2A), PAC (2B) and aldosterone inhibition rate (2C) after CCT ARR, aldosterone to renin ratio; CCT, captopril challenge test; PAC, plasma aldosterone concentration."

Figure 3

Comparison of AUC between ARR before and after CCT ARR, aldosterone to renin ratio; CCT, captopril challenge test; PAC, plasma aldosterone concentration."

Table 3

Diagnostic value of ARR single index and combination with hypokalemia"

Index Cut-off piont AUC Sensitivity/% Specificity/% Diagnostic accuracy/%
① ARR before CCT 7.12 0.67 35.85 77.78 60.0
② ARR after CCT 4.23 0.66 71.43 62.22 64.0
①+② 0.68 64.71 71.11 69.4
①+Hypokalemia 0.71 61.76 81.11 75.8
②+Hypokalemia 0.63 55.88 71.11 66.9
①+②+Hypokalemia 0.69 58.80 78.80 73.4
[1] Funder JW, Carey RM, Mantero F, et al. The management of primary aldosteronism: Case detection, diagnosis, and treatment. An endocrine society clinical practice guideline[J]. J Clin Endocrinol Metab, 2016, 101(5):1889-1916.
doi: 10.1210/jc.2015-4061 pmid: 26934393
[2] Williams TA, Lenders J, Mulatero P, et al. Outcomes after adrenalectomy for unilateral primary aldosteronism: An international consensus on outcome measures and analysis of remission rates in an international cohort[J]. Lancet Diabetes Endocrinol, 2017, 5(9):689-699.
doi: 10.1016/S2213-8587(17)30135-3
[3] Williams TA, Reincke M. Management of endocrine disease: Diagnosis and management of primary aldosteronism: the Endocrine Society guideline 2016 revisited[J]. 2018, 179(1):R19-R29.
[4] 中华医学会内分泌学分会肾上腺学组. 原发性醛固酮增多症诊断治疗的专家共识[J]. 中华内分泌代谢杂志, 2016, 32(3):188-195.
[5] 吴昱. 醛固酮与肾素活性的比值在原发性醛固酮增多症的诊断价值研究[D]. 南宁: 广西医科大学, 2017.
[6] Kline GA, Prebtani A, Leung AA, et al. Primary aldosteronism: A common cause of resistant hypertension[J]. CMAJ, 2017, 189(22):E773-E778.
doi: 10.1503/cmaj.161486
[7] Nishikawa T, Omura M, Satoh F, et al. Guidelines for the diagnosis and treatment of primary aldosteronism: the Japan Endocrine Society 2009[J]. Endocr J, 2011, 58(9):711-721.
pmid: 21828936
[8] Young WF, Stanson AW, Thompson GB, et al. Role for adrenal venous sampling in primary aldosteronism[J]. Surgery, 2004, 136(6):1227-1235.
doi: 10.1016/j.surg.2004.06.051
[9] Kerstens MN, Kobold AC, Volmer M, et al. Reference values for aldosterone-renin ratios in normotensive individuals and effect of changes in dietary sodium consumption[J]. Clin Chem, 2011, 57(11):1607-1611.
doi: 10.1373/clinchem.2011.165662 pmid: 21865483
[10] Burton TJ, Mackenzie IS, Balan K, et al. Evaluation of the sensitivity and specificity of (11) C-metomidate positron emission tomography (PET)-CT for lateralizing aldosterone secretion by Conn’s adenomas[J]. J Clin Endocrinol Metab, 2012, 97(1):100-109.
doi: 10.1210/jc.2011-1537
[11] Lenders J, Eisenhofer G, Reincke M. Subtyping of patients with primary aldosteronism: An update[J]. Horm Metab Res, 2017, 49(12):922-928.
doi: 10.1055/s-0043-122602
[12] Shackleton C. Clinical steroid mass spectrometry: A 45-year history culminating in HPLC-MS/MS becoming an essential tool for patient diagnosis[J]. J Steroid Biochem Mol Biol, 2010, 121(3-5):481-490.
doi: 10.1016/j.jsbmb.2010.02.017
[13] Biglieri EG, Schambelan M. The significance of elevated levels of plasma 18-hydroxycorticosterone in patients with primary aldosteronism[J]. J Clin Endocrinol Metab, 1979, 49(1):87-91.
doi: 10.1210/jcem-49-1-87
[14] Auchus RJ, Chandler DW, Singeetham S, et al. Measurement of 18-hydroxycorticosterone during adrenal vein sampling for primary aldosteronism[J]. J Clin Endocrinol Metab, 2007, 92(7):2648-2651.
doi: 10.1210/jc.2006-2631
[15] 胡枫湫, 黄娟, 黄慧. 原发性醛固酮增多症诊断性试验在醛固酮瘤诊断中的临床应用与评价[J]. 四川大学学报(医学版), 2018, 49(3):469-473.
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