{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,5,29]],"date-time":"2026-05-29T10:11:27Z","timestamp":1780049487723,"version":"3.53.1"},"reference-count":61,"publisher":"Oxford University Press (OUP)","issue":"2","license":[{"start":{"date-parts":[[2024,7,29]],"date-time":"2024-07-29T00:00:00Z","timestamp":1722211200000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/academic.oup.com\/pages\/standard-publication-reuse-rights"}],"funder":[{"DOI":"10.13039\/100000968","name":"American Heart Association","doi-asserted-by":"publisher","id":[{"id":"10.13039\/100000968","id-type":"DOI","asserted-by":"publisher"}]},{"DOI":"10.13039\/501100012264","name":"NIH","doi-asserted-by":"publisher","id":[{"id":"10.13039\/501100012264","id-type":"DOI","asserted-by":"publisher"}]},{"DOI":"10.13039\/100000050","name":"NHLBI","doi-asserted-by":"publisher","award":["K23HL159279"],"award-info":[{"award-number":["K23HL159279"]}],"id":[{"id":"10.13039\/100000050","id-type":"DOI","asserted-by":"publisher"}]},{"DOI":"10.13039\/100000002","name":"National Institutes of Health","doi-asserted-by":"publisher","award":["R01 DK115392"],"award-info":[{"award-number":["R01 DK115392"]}],"id":[{"id":"10.13039\/100000002","id-type":"DOI","asserted-by":"publisher"}]},{"DOI":"10.13039\/100000002","name":"National Institutes of Health","doi-asserted-by":"publisher","award":["R01 HL153004"],"award-info":[{"award-number":["R01 HL153004"]}],"id":[{"id":"10.13039\/100000002","id-type":"DOI","asserted-by":"publisher"}]},{"DOI":"10.13039\/100000002","name":"National Institutes of Health","doi-asserted-by":"publisher","award":["R01 DK16618"],"award-info":[{"award-number":["R01 DK16618"]}],"id":[{"id":"10.13039\/100000002","id-type":"DOI","asserted-by":"publisher"}]},{"DOI":"10.13039\/100000002","name":"National Institutes of Health","doi-asserted-by":"publisher","award":["R01 HL155834"],"award-info":[{"award-number":["R01 HL155834"]}],"id":[{"id":"10.13039\/100000002","id-type":"DOI","asserted-by":"publisher"}]}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":[],"published-print":{"date-parts":[[2024,8,5]]},"abstract":"<jats:title>Abstract<\/jats:title>\n                  <jats:sec>\n                    <jats:title>Background<\/jats:title>\n                    <jats:p>Extracellular calcium critically regulates physiologic aldosterone production. Moreover, abnormal calcium flux and signaling are involved in the pathogenesis of the majority of primary aldosteronism cases.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods<\/jats:title>\n                    <jats:p>We investigated the influence of the saline suppression test (SST) on calcium homeostasis in prospectively recruited participants (n = 86).<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>During SST, 100% of participants had decreases in serum calcium, with 48% developing frank hypocalcemia. Serum calcium declined from 2.30 \u00b1 0.08 mmol\/L to 2.13 \u00b1 0.08 mmol\/L (P &amp;lt; .001) with parallel increases in parathyroid hormone from 6.06 \u00b1 2.39 pmol\/L to 8.13 \u00b1 2.42 pmol\/L (P &amp;lt; .001). In contrast, serum potassium and bicarbonate did not change, whereas eGFR increased and serum glucose decreased (P &amp;lt; .001). Lower body surface area (translating to greater effective circulating volume expansion during SST) was associated with greater reductions in (\u03b2 = .33, P = .001), and absolutely lower, serum calcium levels (\u03b2 = .25, P = .001). When evaluating clinically-relevant diagnostic thresholds, participants with post-SST aldosterone levels &amp;lt;138 pmol\/L had lower post-SST calcium and 25-hydroxyvitamin D levels (P &amp;lt; .05), and higher post-SST parathyroid hormone levels (P &amp;lt; .05) compared with those with post-SST aldosterone levels &amp;gt;277 pmol\/L.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusion<\/jats:title>\n                    <jats:p>SST uniformly decreases serum calcium, which is likely to be due to the combination of variable dilution, increased renal clearance, and vitamin D status. These acute reductions in bioavailable calcium are associated with lower post-SST aldosterone. Given the critical role of extracellular calcium in regulating aldosterone production, these findings warrant renewed inquiry into the validity of SST interpretations for excluding primary aldosteronism.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1093\/ejendo\/lvae099","type":"journal-article","created":{"date-parts":[[2024,7,25]],"date-time":"2024-07-25T18:43:07Z","timestamp":1721932987000},"page":"241-250","source":"Crossref","is-referenced-by-count":6,"title":["Saline suppression testing-induced hypocalcemia and implications for clinical interpretations"],"prefix":"10.1093","volume":"191","author":[{"given":"Wasita W","family":"Parksook","sequence":"first","affiliation":[{"name":"Center for Adrenal Disorders , Boston, MA 02115 ,","place":["United States"]},{"name":"Division of Endocrinology, Diabetes, and Hypertension , Boston, MA 02115 ,","place":["United States"]},{"name":"Department of Medicine, Brigham and Women's Hospital, Harvard Medical School , Boston, MA 02115 ,","place":["United States"]},{"name":"Department of Medicine (Division of Endocrinology and Metabolism, and Division of General Internal Medicine), Faculty of Medicine, Chulalongkorn University, and King Chulalongkorn Memorial Hospital, Thai Red Cross Society , Bangkok 10330 ,","place":["Thailand"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Jenifer M","family":"Brown","sequence":"additional","affiliation":[{"name":"Center for Adrenal Disorders , Boston, MA 02115 ,","place":["United States"]},{"name":"Department of Medicine, Brigham and Women's Hospital, Harvard Medical School , Boston, MA 02115 ,","place":["United States"]},{"name":"Division of Cardiovascular Medicine , Boston, MA 02115 ,","place":["United States"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Julia","family":"Milks","sequence":"additional","affiliation":[{"name":"Center for Adrenal Disorders , Boston, MA 02115 ,","place":["United States"]},{"name":"Division of Endocrinology, Diabetes, and Hypertension , Boston, MA 02115 ,","place":["United States"]},{"name":"Department of Medicine, Brigham and Women's Hospital, Harvard Medical School , Boston, MA 02115 ,","place":["United States"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0009-0008-5344-2589","authenticated-orcid":false,"given":"Laura C","family":"Tsai","sequence":"additional","affiliation":[{"name":"Center for Adrenal Disorders , Boston, MA 02115 ,","place":["United States"]},{"name":"Division of Endocrinology, Diabetes, and Hypertension , Boston, MA 02115 ,","place":["United States"]},{"name":"Department of Medicine, Brigham and Women's Hospital, Harvard Medical School , Boston, MA 02115 ,","place":["United States"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Justin","family":"Chan","sequence":"additional","affiliation":[{"name":"Center for Adrenal Disorders , Boston, MA 02115 ,","place":["United States"]},{"name":"Division of Endocrinology, Diabetes, and Hypertension , Boston, MA 02115 ,","place":["United States"]},{"name":"Department of Medicine, Brigham and Women's Hospital, Harvard Medical School , Boston, MA 02115 ,","place":["United States"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Anna","family":"Moore","sequence":"additional","affiliation":[{"name":"Center for Adrenal Disorders , Boston, MA 02115 ,","place":["United States"]},{"name":"Division of Endocrinology, Diabetes, and Hypertension , Boston, MA 02115 ,","place":["United States"]},{"name":"Department of Medicine, Brigham and Women's Hospital, Harvard Medical School , Boston, MA 02115 ,","place":["United States"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Yvonne","family":"Niebuhr","sequence":"additional","affiliation":[{"name":"Center for Adrenal Disorders , Boston, MA 02115 ,","place":["United States"]},{"name":"Division of Endocrinology, Diabetes, and Hypertension , Boston, MA 02115 ,","place":["United States"]},{"name":"Department of Medicine, Brigham and Women's Hospital, Harvard Medical School , Boston, MA 02115 ,","place":["United States"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Brooke","family":"Honzel","sequence":"additional","affiliation":[{"name":"Center for Adrenal Disorders , Boston, MA 02115 ,","place":["United States"]},{"name":"Division of Endocrinology, Diabetes, and Hypertension , Boston, MA 02115 ,","place":["United States"]},{"name":"Department of Medicine, Brigham and Women's Hospital, Harvard Medical School , Boston, MA 02115 ,","place":["United States"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Andrew J","family":"Newman","sequence":"additional","affiliation":[{"name":"Center for Adrenal Disorders , Boston, MA 02115 ,","place":["United States"]},{"name":"Division of Endocrinology, Diabetes, and Hypertension , Boston, MA 02115 ,","place":["United States"]},{"name":"Department of Medicine, Brigham and Women's Hospital, Harvard Medical School , Boston, MA 02115 ,","place":["United States"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-0314-9252","authenticated-orcid":false,"given":"Anand","family":"Vaidya","sequence":"additional","affiliation":[{"name":"Center for Adrenal Disorders , Boston, MA 02115 ,","place":["United States"]},{"name":"Division of Endocrinology, Diabetes, and Hypertension , Boston, MA 02115 ,","place":["United States"]},{"name":"Department of Medicine, Brigham and Women's Hospital, Harvard Medical School , Boston, MA 02115 ,","place":["United States"]}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"286","published-online":{"date-parts":[[2024,7,29]]},"reference":[{"issue":"2","key":"2026041420244227500_lvae099-B1","doi-asserted-by":"crossref","first-page":"327","DOI":"10.1210\/endo-105-2-327","article-title":"The role of calcium in the stimulation of aldosterone production by adrenocorticotropin, angiotensin II, and 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