Endocrine Abstracts

Introduction: Delayed diagnosis of secondary hypertension, notably primary aldosteronism, challenges healthcare. Inconsistent guideline adherence hampers detection rates and diagnostic uniformity, emphasizing the imperative for improved diagnostic strategies in identifying primary hyperaldosteronism. Our study directly addresses this critical gap in clinical care, underscoring the need for enhanced diagnostics in patients undergoing investigation for secondary endocrine hypertension.

Methods: A retrospective study at a Bucharest tertiary center analyzed 83 consecutive medical records between January 2023 and December 2023 during screening for secondary hypertension. Diagnosing primary hyperaldosteronism involved aldosterone-to-renin ratio (ARR) measurements, with confirmatory saline infusion or captopril suppression tests aligned with the 2016 European Society guideline for hyperaldosteronism. Sensitivity, specificity, and predictive values for ARR cutoffs (38, 57, 77 pg/ml/pg/ml) and confirmatory tests were calculated. Receiver operating characteristic (ROC) curve analysis and the area under the curve (AUC) assessed the diagnostic performance.

Results: In the cohort of 83 patients undergoing screening for secondary hypertension, the gender distribution revealed 31 men (37%) and 52 women (63%), with a median age of 45 years. Of these, 24 cases (28.9%) were diagnosed as primary hyperaldosteronism. Additional diagnoses included 1 case (1.2%) of acromegaly, 13 cases (15.6%) of Cushing syndrome, and 4 cases (4.8%) of pheochromocytoma, while the remaining cases tested negative for secondary endocrine hypertension. At ARR cut-off of 38, the study observed a sensitivity of 88%, specificity of 90%, positive predictive value (PPV) of 78%, and negative predictive value (NPV) of 95%. At ARR cut-offs of 57 and 77, sensitivities were 75%, with specificities of 92% and 98%, respectively. The corresponding positive predictive values (PPV) were 78% and 95%, and negative predictive values (NPV) were 90% and 91%, respectively. In the confirmatory phase, 15 patients underwent the saline infusion test, resulting in 9 positive confirmations (sensitivity: 69%, specificity: 100%, PPV: 100%, NPV: 33%). Nine patients underwent the Captopril suppression test, obtaining 5 positive confirmations and 4 negative results, hindering reliable sensitivity and specificity calculations due to the limited sample size. After ROC curve analysis, the optimal cutoff was 37.25, exhibiting the best balance of sensitivity and specificity (AUC=0.929, P<0.001) in our data set.

Conclusion: The identified cutoff value of 37.25 in our study aligns closely with literature findings, affirming its relevance in diagnosing primary hyperaldosteronism. However, to enhance diagnostic accuracy, additional confirmation tests and a larger patient cohort are crucial, ensuring broader clinical validation.