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Pathology Update 2025
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A Non-Invasive Protocol Aiding Confirmation and Subtyping of Primary Aldosteronism

Roche Scientific E Poster Display

Roche Scientific E-Poster Display

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Chemical Pathology

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Abstracts/Presentation Description

Jenny Yeuk Ki CHENG1,2, Clara Wai Shan LO1,2, Teresa Kam Chi TSUI1,2, Edith Wing Kar CHOW3, Kitty Kit Ting CHEUNG3, Ronald Ching Wan MA3,4,5, Risa OZAKI3, Chung Shun HO1
 
1Department of Chemical Pathology, Prince of Wales Hospital, Hong Kong
2Department of Chemical Pathology, The Chinese University of Hong Kong, Hong Kong
3Department of Medicine and Therapeutics, The Chinese University of Hong Kong, Prince of Wales Hospital, Hong Kong
4Hong Kong Institute of Diabetes and Obesity, The Chinese University of Hong Kong, Hong Kong
5Li Ka Shing Institute of Health Sciences, The Chinese University of Hong Kong, Hong Kong
 
Background: The gold standard for subtyping primary aldosteronism (PA) is adrenal venous sampling, which is invasive and technically demanding. This study evaluated the performance of a non-invasive protocol, balance study, for confirming and subtyping PA.  
 
Methods: The balance study consisted of oral salt loading and postural stimulation tests. Data from 402 patients with confirmed PA or essential hypertension were analyzed. Biochemical markers were measured using liquid chromatography-tandem mass spectrometry. Diagnostic performance for markers was assessed by receiver operating characteristics, with a cut-off of ≥90% specificity.
 
Results: For PA confirmation, urinary aldosterone (UALD; area-under-the-curve [AUC] 0.894), urinary tetrahydroaldosterone (UTHA; AUC 0.875), their sum (SUM; AUC 0.884), and supine plasma aldosterone (PALD; AUC 0.902) showed similar performances. Cut-off values were: UALD >38 nmol/day, UTHA >228 nmol/day, SUM >259 nmol/day, and supine PALD >264 pmol/L. For PA subtyping, the difference or ratio of PALD from supine to erect position achieved an AUC of 0.87. A drop in PALD >52 pmol/L or >9% suggested aldosterone-producing adenoma.
 
Conclusion: The balance study confirmed PA and predicted the subtype. UTHA and supine PALD may add value to UALD for PA confirmation, whereas the difference or ratio between erect and supine PALD could assist PA subtyping.

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Yeuk Ki Cheng -

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