Endocrinol Metab.  2016 Jun;31(2):277-283. 10.3803/EnM.2016.31.2.277.

Diagnostic Role of Captopril Challenge Test in Korean Subjects with High Aldosterone-to-Renin Ratios

Affiliations
  • 1Department of Internal Medicine, Seoul National University College of Medicine, Seoul, Korea. swkimmd@snu.ac.kr
  • 2Department of Internal Medicine, Seoul Metropolitan Government Seoul National University Boramae Medical Center, Seoul National University College of Medicine, Seoul, Korea.

Abstract

BACKGROUND
Diagnosis of primary aldosteronism (PA) begins with aldosterone-to-renin ratio (ARR) measurement followed by confirmative tests. However, the ARR has high false positive rates which led to unnecessary confirmatory tests. Captopril challenge test (CCT) has been used as one of confirmatory tests, but the accuracy of it in the diagnosis of PA is still controversial. We aimed to examine the clinical efficacy of CCT as a post-screening test in PA.
METHODS
In a prospective study, we enrolled subjects with suspected PA who had hypertension and ARR >20 (ng/dL)/(ng/mL/hr). Sixty-four patients who underwent both the saline infusion test and the CCT were included.
RESULTS
The diagnostic performance of plasma aldosterone concentration (PAC) post-CCT was greater than that of ARR post-CCT and ARR pre-CCT in PA (area under the curve=0.956, 0.797, and 0.748, respectively; P=0.001). A cut-off value of 13 ng/dL showed the highest diagnostic odds ratio considering PAC post-CCT at 60 and 90 minutes. A PAC post-CCT of 19 ng/dL had a specificity of 100%, which can be used as a cut-off value for the confirmative test. Determining the diagnostic performance of PAC post-CCT at 90 minutes was sufficient for PA diagnosis. Subjects with PAC post-CCT at 90 minutes <13 ng/dL are less likely to have PA, and those with PAC post-CCT at 90 minutes ≥13 but <19 ng/dL should undergo secondary confirmatory tests.
CONCLUSION
The CCT test may be a reliable post-screening test to avoid the hospitalization in the setting of falsely elevated ARR screening tests.

Keyword

Captopril challenge test; Aldosterone-to-renin ratio; Plasma aldosterone concentrations; Screening test; Primary aldosteronism

MeSH Terms

Aldosterone
Captopril*
Diagnosis
Hospitalization
Humans
Hyperaldosteronism
Hypertension
Mass Screening
Odds Ratio
Plasma
Prospective Studies
Sensitivity and Specificity
Treatment Outcome
Aldosterone
Captopril

Figure

  • Fig. 1 The flow diagram of the study subjects. All patients underwent both saline infusion test (SIT) and captopril challenge test (CCT). If positive result of SIT and CCT, adrenal venous sampling was conducted for distinguishing aldosterone producing adenoma (APA) and idiopathic hyperaldosteronism (IHA). ARR, aldosterone-to-renin ratio; PA, primary aldosteronism; EH, essential hypertension.

  • Fig. 2 Receiver operating characteristic curve analysis for aldosterone-to-renin ratio (ARR), ARR post-captopril challenge test (CCT), and plasma aldosterone concentration (PAC) post-CCT for the diagnosis of primary aldosteronism. PAC post-CCT showed very accruable with large area under the curve (AUC). The black line represents the results equivalent to chance.

  • Fig. 3 Plasma aldosterone concentration (PAC) post-captopril challenge test (CCT) at 90 minutes in patients with essential hypertension (EH) and primary aldosteronism (PA).


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