Journal of the Endocrine Society · 2023
Efficacy of Oral Furosemide Test for Primary Aldosteronism Diagnosis.
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Freitas Thais C, Maciel Ana Alice W, Fagundes Gustavo F C, Petenuci Janaina, Santana Lucas S, Guimaraes Augusto G, Freitas-Castro Felipe, Srougi Victor, Tanno Fabio Y, Chambo Jose L, Pereira Maria Adelaide A, Brito Luciana P, Pio-Abreu Andrea, Bortolotto Luiz A, Latronico Ana Claudia, Fragoso Maria Candida B V, Drager Luciano F, Mendonca Berenice B, Almeida Madson Q
Аннотация
CONTEXT: Confirmatory tests represent a fundamental step in primary aldosteronism (PA) diagnosis, but they are laborious and often require a hospital environment due to the risks involved.
OBJECTIVE: To evaluate the efficacy of oral furosemide as a new confirmatory test for PA diagnosis.
METHODS: We prospectively evaluated the diagnostic performance of 80 mg of oral furosemide in 64 patients with PA and 22 with primary hypertension (controls). Direct renin concentration (DRC) was measured before, and 2 hours and 3 hours after the oral furosemide. In addition, the oral furosemide test was compared with 2 other confirmatory tests: the furosemide upright test (FUT) and saline infusion test (SIT) or captopril challenge test (CCT) in all patients with PA.
RESULTS: The cut-off of 7.6 µU/mL for DRC at 2 hours after oral furosemide had a sensitivity of 92%, specificity of 82%, and accuracy of 90% for PA diagnosis. In 5 out of 6 controls with low-renin hypertension, which might represent a PA spectrum, renin remained suppressed. Excluding these 6 controls with low-renin hypertension, the DRC cut-off of 10 µU/mL at 2 hours after oral furosemide had a sensitivity of 95.3%, specificity of 93.7% and accuracy of 95% for PA diagnosis. DRC after 3 hours of oral furosemide did not improve diagnostic performance. Using the cut-off of 10 µU/mL, the oral furosemide test and the FUT were concordant in 62 out of 64 (97%) patients with PA. Only 4 out of 64 cases with PA (6.4%) ended the oral furosemide test with potassium <3.5 mEq/L. Hypotension was not evidenced in any patient with PA during the test.
CONCLUSION: The oral furosemide test was safe, well-tolerated and represents an effective strategy for PA investigation.
OBJECTIVE: To evaluate the efficacy of oral furosemide as a new confirmatory test for PA diagnosis.
METHODS: We prospectively evaluated the diagnostic performance of 80 mg of oral furosemide in 64 patients with PA and 22 with primary hypertension (controls). Direct renin concentration (DRC) was measured before, and 2 hours and 3 hours after the oral furosemide. In addition, the oral furosemide test was compared with 2 other confirmatory tests: the furosemide upright test (FUT) and saline infusion test (SIT) or captopril challenge test (CCT) in all patients with PA.
RESULTS: The cut-off of 7.6 µU/mL for DRC at 2 hours after oral furosemide had a sensitivity of 92%, specificity of 82%, and accuracy of 90% for PA diagnosis. In 5 out of 6 controls with low-renin hypertension, which might represent a PA spectrum, renin remained suppressed. Excluding these 6 controls with low-renin hypertension, the DRC cut-off of 10 µU/mL at 2 hours after oral furosemide had a sensitivity of 95.3%, specificity of 93.7% and accuracy of 95% for PA diagnosis. DRC after 3 hours of oral furosemide did not improve diagnostic performance. Using the cut-off of 10 µU/mL, the oral furosemide test and the FUT were concordant in 62 out of 64 (97%) patients with PA. Only 4 out of 64 cases with PA (6.4%) ended the oral furosemide test with potassium <3.5 mEq/L. Hypotension was not evidenced in any patient with PA during the test.
CONCLUSION: The oral furosemide test was safe, well-tolerated and represents an effective strategy for PA investigation.