The following is a summary of “Exclusion Tests in Unilateral Primary Aldosteronism (ExcluPA) Study,” published in the February 2023 issue of Endocrinology & Metabolism by Zhu, et al.
For a study, researchers sought to assess the diagnostic accuracy of “exclusion” tests for primary aldosteronism (PA) compared to the aldosterone to renin ratio (ARR), with a focus on the diagnosis of unilateral PA as the reference standard.
To achieve this, they searched four major databases (PubMed, EMBASE, Web of Science, and Cochrane Library) for studies published from January 1, 1970, to December 31, 2021, that met tight quality criteria. As a result, the study identified 31 datasets comprising 4,242 patients that met the inclusion criteria. The data were extracted following the PRISMA methodology. First, the study performed a two-stage meta-analysis, consisting of an exploratory and a validation phase based on a “golden” or “gold” diagnostic standard, respectively. Then, the pooled specificity, negative likelihood ratio, diagnostic odds ratio, and summary area under the ROC curve (sAUROC) were calculated to analyze the accuracy of exclusion tests.
The results of the meta-analysis showed that the pooled accuracy estimates (sAUROC) did not differ between the ARR (0.95; 95% CI, 0.92-0.98), the captopril challenge test (CCT) (0.92; 95% CI, 0.88-0.97), and the saline infusion test (SIT) (0.96; 95% CI, 0.94-0.99). However, the fludrocortisone suppression test and the furosemide upright test were assessed in only one study each, and solid information could not be obtained for these tests.
The study concluded that the high diagnostic accuracy of the CCT and the SIT was due to the selection of patients with an elevated ARR and a high pretest probability of unilateral PA. The systematic use of exclusion tests in clinical practice was not justified by available evidence, and the ARR remained the most accurate test for diagnosing PA.
Reference: academic.oup.com/jcem/article-abstract/108/2/496/6825590?redirectedFrom=fulltext