Safety of medical adjustment and confirmatory testing in the diagnostic work-up of primary aldosteronism
Objective Saline infusion test (SIT) and captopril challenge test (CCT) are standard confirmatory procedures routinely used in the diagnostic work-up of primary aldosteronism (PA). However, side effects and complications during testing have not been systematically studied. Design We performed a coho...
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| Veröffentlicht in: | European journal of endocrinology 2019-10, Vol.181 (4), p.421-428 |
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| container_title | European journal of endocrinology |
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| creator | Heinrich, Daniel A Adolf, Christian Quinkler, Marcus Holler, Finn Lechner, Benjamin Nirschl, Nina Sturm, Lisa Görge, Veronika Beuschlein, Felix Reincke, Martin |
| description | Objective Saline infusion test (SIT) and captopril challenge test (CCT) are standard confirmatory procedures routinely used in the diagnostic work-up of primary aldosteronism (PA). However, side effects and complications during testing have not been systematically studied. Design We performed a cohort study with patients undergoing SIT and/or CCT in two centers from 2016 until 2018. Methods We studied 272 study participants with suspected PA enrolled at two outpatient centers in Germany. We assessed the frequency and severity of side effects during adjustment of blood pressure medication and during SIT and CCT. Results During the adjustment phase prior confirmatory testing, side effects including palpitations, headaches, edema and hypertensive episodes occurred in 18.4% of study participants. Side effects were associated with higher defined daily doses (DDD) (r = 0.25, P |
| doi_str_mv | 10.1530/EJE-19-0138 |
| format | Article |
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However, side effects and complications during testing have not been systematically studied. Design We performed a cohort study with patients undergoing SIT and/or CCT in two centers from 2016 until 2018. Methods We studied 272 study participants with suspected PA enrolled at two outpatient centers in Germany. We assessed the frequency and severity of side effects during adjustment of blood pressure medication and during SIT and CCT. Results During the adjustment phase prior confirmatory testing, side effects including palpitations, headaches, edema and hypertensive episodes occurred in 18.4% of study participants. Side effects were associated with higher defined daily doses (DDD) (r = 0.25, P < 0.005), number of antihypertensive drugs (r = 0.285, P < 0.005) and higher blood pressure (r = 0.145, P = 0.019). During SIT, 17.5% of study participants had side effects, associated with higher blood pressure (systolic: r = 0.541, P < 0.0005; diastolic: r = 0.426, P < 0.0005) and DDDs (r = 0.727, P < 0.0005). During CCT, only 1.5% of study participants developed side effects. Conclusions In contrast to the high rate of side effects during SIT, CCT appears to be the safer test with a very low event rate. This makes CCT especially suitable for severely hypertensive patients.</description><identifier>ISSN: 0804-4643</identifier><identifier>EISSN: 1479-683X</identifier><identifier>DOI: 10.1530/EJE-19-0138</identifier><identifier>PMID: 31376812</identifier><language>eng</language><publisher>England: Bioscientifica Ltd</publisher><subject>Adult ; Antihypertensives ; Blood pressure ; Clinical Study ; Cohort Studies ; Diagnostic Tests, Routine - adverse effects ; Diagnostic Tests, Routine - standards ; Edema ; Endocrine disorders ; Female ; Headache ; Humans ; Hyperaldosteronism - blood ; Hyperaldosteronism - diagnosis ; Hypertension ; Male ; Middle Aged ; Patient Safety - standards ; Side effects</subject><ispartof>European journal of endocrinology, 2019-10, Vol.181 (4), p.421-428</ispartof><rights>2019 European Society of Endocrinology</rights><rights>Copyright BioScientifica Ltd. Oct 2019</rights><lds50>peer_reviewed</lds50><oa>free_for_read</oa><woscitedreferencessubscribed>false</woscitedreferencessubscribed><citedby>FETCH-LOGICAL-b462t-2f269e9ab7bef519d8b3fe384d09b3ab38bb589d81bd64d551edf091cee485fd3</citedby></display><links><openurl>$$Topenurl_article</openurl><openurlfulltext>$$Topenurlfull_article</openurlfulltext><thumbnail>$$Tsyndetics_thumb_exl</thumbnail><link.rule.ids>314,776,780,27901,27902</link.rule.ids><backlink>$$Uhttps://www.ncbi.nlm.nih.gov/pubmed/31376812$$D View this record in MEDLINE/PubMed$$Hfree_for_read</backlink></links><search><creatorcontrib>Heinrich, Daniel A</creatorcontrib><creatorcontrib>Adolf, Christian</creatorcontrib><creatorcontrib>Quinkler, Marcus</creatorcontrib><creatorcontrib>Holler, Finn</creatorcontrib><creatorcontrib>Lechner, Benjamin</creatorcontrib><creatorcontrib>Nirschl, Nina</creatorcontrib><creatorcontrib>Sturm, Lisa</creatorcontrib><creatorcontrib>Görge, Veronika</creatorcontrib><creatorcontrib>Beuschlein, Felix</creatorcontrib><creatorcontrib>Reincke, Martin</creatorcontrib><title>Safety of medical adjustment and confirmatory testing in the diagnostic work-up of primary aldosteronism</title><title>European journal of endocrinology</title><addtitle>Eur J Endocrinol</addtitle><description>Objective Saline infusion test (SIT) and captopril challenge test (CCT) are standard confirmatory procedures routinely used in the diagnostic work-up of primary aldosteronism (PA). However, side effects and complications during testing have not been systematically studied. Design We performed a cohort study with patients undergoing SIT and/or CCT in two centers from 2016 until 2018. Methods We studied 272 study participants with suspected PA enrolled at two outpatient centers in Germany. We assessed the frequency and severity of side effects during adjustment of blood pressure medication and during SIT and CCT. Results During the adjustment phase prior confirmatory testing, side effects including palpitations, headaches, edema and hypertensive episodes occurred in 18.4% of study participants. Side effects were associated with higher defined daily doses (DDD) (r = 0.25, P < 0.005), number of antihypertensive drugs (r = 0.285, P < 0.005) and higher blood pressure (r = 0.145, P = 0.019). During SIT, 17.5% of study participants had side effects, associated with higher blood pressure (systolic: r = 0.541, P < 0.0005; diastolic: r = 0.426, P < 0.0005) and DDDs (r = 0.727, P < 0.0005). During CCT, only 1.5% of study participants developed side effects. Conclusions In contrast to the high rate of side effects during SIT, CCT appears to be the safer test with a very low event rate. This makes CCT especially suitable for severely hypertensive patients.</description><subject>Adult</subject><subject>Antihypertensives</subject><subject>Blood pressure</subject><subject>Clinical Study</subject><subject>Cohort Studies</subject><subject>Diagnostic Tests, Routine - adverse effects</subject><subject>Diagnostic Tests, Routine - standards</subject><subject>Edema</subject><subject>Endocrine disorders</subject><subject>Female</subject><subject>Headache</subject><subject>Humans</subject><subject>Hyperaldosteronism - blood</subject><subject>Hyperaldosteronism - diagnosis</subject><subject>Hypertension</subject><subject>Male</subject><subject>Middle Aged</subject><subject>Patient Safety - standards</subject><subject>Side effects</subject><issn>0804-4643</issn><issn>1479-683X</issn><fulltext>true</fulltext><rsrctype>article</rsrctype><creationdate>2019</creationdate><recordtype>article</recordtype><sourceid>EIF</sourceid><recordid>eNp9kUtLAzEURoMoWh8r9xJwI8hoXjPNLKXUFwUXKrgLySSpqTNJTWaQ_ntTWl24cJVwc_i4OR8Apxhd4ZKi6-njtMB1gTDlO2CE2bguKk7fdsEIccQKVjF6AA5TWiCE8x3tgwOK6bjimIzA-7O0pl_BYGFntGtkC6VeDKnvjO-h9Bo2wVsXO9mHuIK9Sb3zc-g87N8N1E7OfcijBn6F-FEMy3XQMrpOZli2Or-ZGLxL3THYs7JN5mR7HoHX2-nL5L6YPd09TG5mhWIV6QtiSVWbWqqxMrbEteaKWkM506hWVCrKlSp5HmOlK6bLEhttUY0bYxgvraZH4GKTu4zhc8jris6lxrSt9CYMSRCS5RBEyDij53_QRRiiz9sJQlGJOCv5mrrcUE0MKUVjxfZ_AiOxLkDkAgSuxbqATJ9tMweVhf6yP8YzgDeAciE1Llt2Nmv_N_QbmXCSYw</recordid><startdate>20191001</startdate><enddate>20191001</enddate><creator>Heinrich, Daniel A</creator><creator>Adolf, Christian</creator><creator>Quinkler, Marcus</creator><creator>Holler, Finn</creator><creator>Lechner, Benjamin</creator><creator>Nirschl, Nina</creator><creator>Sturm, Lisa</creator><creator>Görge, Veronika</creator><creator>Beuschlein, Felix</creator><creator>Reincke, Martin</creator><general>Bioscientifica Ltd</general><general>Oxford University Press</general><scope>CGR</scope><scope>CUY</scope><scope>CVF</scope><scope>ECM</scope><scope>EIF</scope><scope>NPM</scope><scope>AAYXX</scope><scope>CITATION</scope><scope>7T5</scope><scope>H94</scope><scope>7X8</scope></search><sort><creationdate>20191001</creationdate><title>Safety of medical adjustment and confirmatory testing in the diagnostic work-up of primary aldosteronism</title><author>Heinrich, Daniel A ; Adolf, Christian ; Quinkler, Marcus ; Holler, Finn ; Lechner, Benjamin ; Nirschl, Nina ; Sturm, Lisa ; Görge, Veronika ; Beuschlein, Felix ; Reincke, Martin</author></sort><facets><frbrtype>5</frbrtype><frbrgroupid>cdi_FETCH-LOGICAL-b462t-2f269e9ab7bef519d8b3fe384d09b3ab38bb589d81bd64d551edf091cee485fd3</frbrgroupid><rsrctype>articles</rsrctype><prefilter>articles</prefilter><language>eng</language><creationdate>2019</creationdate><topic>Adult</topic><topic>Antihypertensives</topic><topic>Blood pressure</topic><topic>Clinical Study</topic><topic>Cohort Studies</topic><topic>Diagnostic Tests, Routine - adverse effects</topic><topic>Diagnostic Tests, Routine - standards</topic><topic>Edema</topic><topic>Endocrine disorders</topic><topic>Female</topic><topic>Headache</topic><topic>Humans</topic><topic>Hyperaldosteronism - blood</topic><topic>Hyperaldosteronism - diagnosis</topic><topic>Hypertension</topic><topic>Male</topic><topic>Middle Aged</topic><topic>Patient Safety - standards</topic><topic>Side effects</topic><toplevel>peer_reviewed</toplevel><toplevel>online_resources</toplevel><creatorcontrib>Heinrich, Daniel A</creatorcontrib><creatorcontrib>Adolf, Christian</creatorcontrib><creatorcontrib>Quinkler, Marcus</creatorcontrib><creatorcontrib>Holler, Finn</creatorcontrib><creatorcontrib>Lechner, Benjamin</creatorcontrib><creatorcontrib>Nirschl, Nina</creatorcontrib><creatorcontrib>Sturm, Lisa</creatorcontrib><creatorcontrib>Görge, Veronika</creatorcontrib><creatorcontrib>Beuschlein, Felix</creatorcontrib><creatorcontrib>Reincke, Martin</creatorcontrib><collection>Medline</collection><collection>MEDLINE</collection><collection>MEDLINE (Ovid)</collection><collection>MEDLINE</collection><collection>MEDLINE</collection><collection>PubMed</collection><collection>CrossRef</collection><collection>Immunology Abstracts</collection><collection>AIDS and Cancer Research Abstracts</collection><collection>MEDLINE - Academic</collection><jtitle>European journal of endocrinology</jtitle></facets><delivery><delcategory>Remote Search Resource</delcategory><fulltext>fulltext</fulltext></delivery><addata><au>Heinrich, Daniel A</au><au>Adolf, Christian</au><au>Quinkler, Marcus</au><au>Holler, Finn</au><au>Lechner, Benjamin</au><au>Nirschl, Nina</au><au>Sturm, Lisa</au><au>Görge, Veronika</au><au>Beuschlein, Felix</au><au>Reincke, Martin</au><format>journal</format><genre>article</genre><ristype>JOUR</ristype><atitle>Safety of medical adjustment and confirmatory testing in the diagnostic work-up of primary aldosteronism</atitle><jtitle>European journal of endocrinology</jtitle><addtitle>Eur J Endocrinol</addtitle><date>2019-10-01</date><risdate>2019</risdate><volume>181</volume><issue>4</issue><spage>421</spage><epage>428</epage><pages>421-428</pages><issn>0804-4643</issn><eissn>1479-683X</eissn><abstract>Objective Saline infusion test (SIT) and captopril challenge test (CCT) are standard confirmatory procedures routinely used in the diagnostic work-up of primary aldosteronism (PA). However, side effects and complications during testing have not been systematically studied. Design We performed a cohort study with patients undergoing SIT and/or CCT in two centers from 2016 until 2018. Methods We studied 272 study participants with suspected PA enrolled at two outpatient centers in Germany. We assessed the frequency and severity of side effects during adjustment of blood pressure medication and during SIT and CCT. Results During the adjustment phase prior confirmatory testing, side effects including palpitations, headaches, edema and hypertensive episodes occurred in 18.4% of study participants. Side effects were associated with higher defined daily doses (DDD) (r = 0.25, P < 0.005), number of antihypertensive drugs (r = 0.285, P < 0.005) and higher blood pressure (r = 0.145, P = 0.019). During SIT, 17.5% of study participants had side effects, associated with higher blood pressure (systolic: r = 0.541, P < 0.0005; diastolic: r = 0.426, P < 0.0005) and DDDs (r = 0.727, P < 0.0005). During CCT, only 1.5% of study participants developed side effects. Conclusions In contrast to the high rate of side effects during SIT, CCT appears to be the safer test with a very low event rate. This makes CCT especially suitable for severely hypertensive patients.</abstract><cop>England</cop><pub>Bioscientifica Ltd</pub><pmid>31376812</pmid><doi>10.1530/EJE-19-0138</doi><tpages>8</tpages><oa>free_for_read</oa></addata></record> |
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| subjects | Adult Antihypertensives Blood pressure Clinical Study Cohort Studies Diagnostic Tests, Routine - adverse effects Diagnostic Tests, Routine - standards Edema Endocrine disorders Female Headache Humans Hyperaldosteronism - blood Hyperaldosteronism - diagnosis Hypertension Male Middle Aged Patient Safety - standards Side effects |
| title | Safety of medical adjustment and confirmatory testing in the diagnostic work-up of primary aldosteronism |
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