{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,7,23]],"date-time":"2026-07-23T02:39:15Z","timestamp":1784774355907,"version":"3.55.0"},"reference-count":22,"publisher":"The Endocrine Society","issue":"4","license":[{"start":{"date-parts":[[2020,12,30]],"date-time":"2020-12-30T00:00:00Z","timestamp":1609286400000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/academic.oup.com\/journals\/pages\/open_access\/funder_policies\/chorus\/standard_publication_model"}],"funder":[{"DOI":"10.13039\/501100003042","name":"Else Kr\u00f6ner-Fresenius Stiftung","doi-asserted-by":"crossref","award":["2013_A182"],"award-info":[{"award-number":["2013_A182"]}],"id":[{"id":"10.13039\/501100003042","id-type":"DOI","asserted-by":"crossref"}]},{"DOI":"10.13039\/501100003042","name":"Else Kr\u00f6ner-Fresenius Stiftung","doi-asserted-by":"crossref","award":["2015_A171"],"award-info":[{"award-number":["2015_A171"]}],"id":[{"id":"10.13039\/501100003042","id-type":"DOI","asserted-by":"crossref"}]},{"DOI":"10.13039\/501100003042","name":"Else Kr\u00f6ner-Fresenius Stiftung","doi-asserted-by":"crossref","award":["2019_A104"],"award-info":[{"award-number":["2019_A104"]}],"id":[{"id":"10.13039\/501100003042","id-type":"DOI","asserted-by":"crossref"}]},{"DOI":"10.13039\/501100001659","name":"Deutsche Forschungsgemeinschaft","doi-asserted-by":"publisher","id":[{"id":"10.13039\/501100001659","id-type":"DOI","asserted-by":"publisher"}]}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":[],"published-print":{"date-parts":[[2021,3,25]]},"abstract":"<jats:title>Abstract<\/jats:title><jats:sec><jats:title>Context<\/jats:title><jats:p>The diagnostic work-up of primary aldosteronism (PA) includes screening and confirmation steps. Case confirmation is time-consuming, expensive, and there is no consensus on tests and thresholds to be used. Diagnostic algorithms to avoid confirmatory testing may be useful for the management of patients with PA.<\/jats:p><\/jats:sec><jats:sec><jats:title>Objective<\/jats:title><jats:p>Development and validation of diagnostic models to confirm or exclude PA diagnosis in patients with a positive screening test.<\/jats:p><\/jats:sec><jats:sec><jats:title>Design, Patients, and Setting<\/jats:title><jats:p>We evaluated 1024 patients who underwent confirmatory testing for PA. The diagnostic models were developed in a training cohort (n = 522), and then tested on an internal validation cohort (n = 174) and on an independent external prospective cohort (n = 328).<\/jats:p><\/jats:sec><jats:sec><jats:title>Main Outcome Measure<\/jats:title><jats:p>Different diagnostic models and a 16-point score were developed by machine learning and regression analysis to discriminate patients with a confirmed diagnosis of PA.<\/jats:p><\/jats:sec><jats:sec><jats:title>Results<\/jats:title><jats:p>Male sex, antihypertensive medication, plasma renin activity, aldosterone, potassium levels, and the presence of organ damage were associated with a confirmed diagnosis of PA. Machine learning-based models displayed an accuracy of 72.9%\u201383.9%. The Primary Aldosteronism Confirmatory Testing (PACT) score correctly classified 84.1% at training and 83.9% or 81.1% at internal and external validation, respectively. A flow chart employing the PACT score to select patients for confirmatory testing correctly managed all patients and resulted in a 22.8% reduction in the number of confirmatory tests.<\/jats:p><\/jats:sec><jats:sec><jats:title>Conclusions<\/jats:title><jats:p>The integration of diagnostic modeling algorithms in clinical practice may improve the management of patients with PA by circumventing unnecessary confirmatory testing.<\/jats:p><\/jats:sec>","DOI":"10.1210\/clinem\/dgaa974","type":"journal-article","created":{"date-parts":[[2020,12,30]],"date-time":"2020-12-30T14:39:50Z","timestamp":1609339190000},"page":"1708-1716","source":"Crossref","is-referenced-by-count":26,"title":["Development of a Prediction Score to Avoid Confirmatory Testing in Patients With Suspected Primary Aldosteronism"],"prefix":"10.1210","volume":"106","author":[{"given":"Jacopo","family":"Burrello","sequence":"first","affiliation":[{"name":"Division of Internal Medicine and Hypertension, Department of Medical Sciences, University of Torino, Torino, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Martina","family":"Amongero","sequence":"additional","affiliation":[{"name":"Department of Mathematical Sciences G. L. Lagrange, Polytechnic University of Torino, Torino, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-9363-0199","authenticated-orcid":false,"given":"Fabrizio","family":"Buffolo","sequence":"additional","affiliation":[{"name":"Division of Internal Medicine and Hypertension, Department of Medical Sciences, University of Torino, Torino, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Elisa","family":"Sconfienza","sequence":"additional","affiliation":[{"name":"Division of Internal Medicine and Hypertension, Department of Medical Sciences, University of Torino, Torino, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Vittorio","family":"Forestiero","sequence":"additional","affiliation":[{"name":"Division of Internal Medicine and Hypertension, Department of Medical Sciences, University of Torino, Torino, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-6215-8220","authenticated-orcid":false,"given":"Alessio","family":"Burrello","sequence":"additional","affiliation":[{"name":"Department of Electrical, Electronic and Information Engineering \u201cGuglielmo Marconi\u201d (DEI), University of Bologna, Bologna, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-9206-0953","authenticated-orcid":false,"given":"Christian","family":"Adolf","sequence":"additional","affiliation":[{"name":"Medizinische Klinik und Poliklinik IV, Klinikum der Universit\u00e4t, Ludwig-Maximilians-Universit\u00e4t M\u00fcnchen, Munich, Germany"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Laura","family":"Handgriff","sequence":"additional","affiliation":[{"name":"Medizinische Klinik und Poliklinik IV, Klinikum der Universit\u00e4t, Ludwig-Maximilians-Universit\u00e4t M\u00fcnchen, Munich, Germany"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-9817-9875","authenticated-orcid":false,"given":"Martin","family":"Reincke","sequence":"additional","affiliation":[{"name":"Medizinische Klinik und Poliklinik IV, Klinikum der Universit\u00e4t, Ludwig-Maximilians-Universit\u00e4t M\u00fcnchen, Munich, Germany"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-6654-6247","authenticated-orcid":false,"given":"Franco","family":"Veglio","sequence":"additional","affiliation":[{"name":"Division of Internal Medicine and Hypertension, Department of Medical Sciences, University of Torino, Torino, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-2388-6444","authenticated-orcid":false,"given":"Tracy Ann","family":"Williams","sequence":"additional","affiliation":[{"name":"Division of Internal Medicine and Hypertension, Department of Medical Sciences, University of Torino, Torino, Italy"},{"name":"Medizinische Klinik und Poliklinik IV, Klinikum der Universit\u00e4t, Ludwig-Maximilians-Universit\u00e4t M\u00fcnchen, Munich, Germany"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Silvia","family":"Monticone","sequence":"additional","affiliation":[{"name":"Division of Internal Medicine and Hypertension, Department of Medical Sciences, University of Torino, Torino, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Paolo","family":"Mulatero","sequence":"additional","affiliation":[{"name":"Division of Internal Medicine and Hypertension, Department of Medical Sciences, University of Torino, Torino, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"80","published-online":{"date-parts":[[2020,12,30]]},"reference":[{"issue":"5","key":"2021122205224296100_CIT0001","doi-asserted-by":"crossref","first-page":"1889","DOI":"10.1210\/jc.2015-4061","article-title":"The management of primary aldosteronism: case detection, diagnosis, and treatment: an Endocrine Society clinical practice guideline","volume":"101","author":"Funder","year":"2016","journal-title":"J Clin Endocrinol Metab."},{"issue":"10","key":"2021122205224296100_CIT0002","doi-asserted-by":"crossref","first-page":"1919","DOI":"10.1097\/HJH.0000000000002510","article-title":"Genetics, prevalence, screening and confirmation of primary aldosteronism: a position statement and consensus of the Working Group on Endocrine Hypertension of The European Society of Hypertension","volume":"38","author":"Mulatero","year":"2020","journal-title":"J Hypertens."},{"issue":"14","key":"2021122205224296100_CIT0003","doi-asserted-by":"crossref","first-page":"1811","DOI":"10.1016\/j.jacc.2017.01.052","article-title":"Prevalence and clinical manifestations of primary aldosteronism encountered in primary care practice","volume":"69","author":"Monticone","year":"2017","journal-title":"J Am Coll Cardiol."},{"issue":"9","key":"2021122205224296100_CIT0004","doi-asserted-by":"crossref","first-page":"711","DOI":"10.1507\/endocrj.EJ11-0133","article-title":"Guidelines for the diagnosis and treatment of primary aldosteronism\u2013the Japan Endocrine Society 2009","volume":"58","author":"Nishikawa","year":"2011","journal-title":"Endocr J."},{"key":"2021122205224296100_CIT0005","doi-asserted-by":"crossref","DOI":"10.1210\/clinem\/dgaa974","article-title":"Data from: development and validation of a prediction score to avoid confirmatory testing in patients with suspected primary aldosteronism","author":"Burrello","year":"2021","journal-title":"J Clin Endocrinol Metab."},{"issue":"10","key":"2021122205224296100_CIT0006","doi-asserted-by":"crossref","first-page":"1929","DOI":"10.1097\/HJH.0000000000002520","article-title":"Subtype diagnosis, treatment, complications, and outcomes of primary aldosteronism and future direction of research: a position statement and consensus of the Working Group on Endocrine Hypertension of the European Society of Hypertension","volume":"38","author":"Mulatero","year":"2020","journal-title":"J Hypertens."},{"issue":"6","key":"2021122205224296100_CIT0007","doi-asserted-by":"crossref","first-page":"1125","DOI":"10.1097\/SLA.0000000000003200","article-title":"The primary aldosteronism surgical outcome score for the prediction of clinical outcomes after adrenalectomy for unilateral primary aldosteronism","volume":"272","author":"Burrello","year":"2020","journal-title":"Ann Surg."},{"issue":"8","key":"2021122205224296100_CIT0008","doi-asserted-by":"crossref","first-page":"2745","DOI":"10.1210\/jc.2014-1153","article-title":"Seated saline suppression testing for the diagnosis of primary aldosteronism: a preliminary study","volume":"99","author":"Ahmed","year":"2014","journal-title":"J Clin Endocrinol Metab."},{"issue":"10060","key":"2021122205224296100_CIT0009","doi-asserted-by":"crossref","first-page":"2665","DOI":"10.1016\/S0140-6736(16)31134-5","article-title":"A call to action and a lifecourse strategy to address the global burden of raised blood pressure on current and future generations: the Lancet Commission on hypertension","volume":"388","author":"Olsen","year":"2016","journal-title":"Lancet."},{"issue":"4","key":"2021122205224296100_CIT0010","doi-asserted-by":"crossref","first-page":"421","DOI":"10.1530\/EJE-19-0138","article-title":"Safety of medical adjustment and confirmatory testing in the diagnostic work-up of primary aldosteronism","volume":"181","author":"Heinrich","year":"2019","journal-title":"Eur J Endocrinol."},{"issue":"11","key":"2021122205224296100_CIT0011","doi-asserted-by":"crossref","first-page":"2253","DOI":"10.1097\/HJH.0000000000001088","article-title":"Guidelines for primary aldosteronism: uptake by primary care physicians in Europe","volume":"34","author":"Mulatero","year":"2016","journal-title":"J Hypertens."},{"issue":"6","key":"2021122205224296100_CIT0012","doi-asserted-by":"crossref","first-page":"621","DOI":"10.1161\/CIRCOUTCOMES.115.002002","article-title":"Cost-effectiveness of screening for primary aldosteronism and subtype diagnosis in the resistant hypertensive patients","volume":"8","author":"Lubitz","year":"2015","journal-title":"Circ Cardiovasc Qual Outcomes."},{"issue":"5","key":"2021122205224296100_CIT0013","doi-asserted-by":"crossref","first-page":"1688","DOI":"10.1210\/jc.2011-2504","article-title":"Confirmatory testing in primary aldosteronism","volume":"97","author":"Nanba","year":"2012","journal-title":"J Clin Endocrinol Metab."},{"key":"2021122205224296100_CIT0014","doi-asserted-by":"crossref","first-page":"e005574","DOI":"10.1161\/JAHA.117.005574","article-title":"Quantitative value of aldosterone-renin ratio for detection of aldosterone-producing adenoma: The Aldosterone-Renin Ratio for Primary Aldosteronism (AQUARR) Study","volume":"6(5)","author":"Maiolino","year":"2017","journal-title":"J Am Heart Assoc."},{"issue":"3","key":"2021122205224296100_CIT0015","doi-asserted-by":"crossref","first-page":"202","DOI":"10.1016\/j.ando.2016.01.007","article-title":"SFE\/SFHTA\/AFCE consensus on primary aldosteronism, part 3: confirmatory testing","volume":"77","author":"Reznik","year":"2016","journal-title":"Ann Endocrinol (Paris)."},{"issue":"3","key":"2021122205224296100_CIT0016","doi-asserted-by":"crossref","first-page":"172","DOI":"10.1055\/a-0857-1620","article-title":"Evaluation of biochemical conditions allowing bypass of confirmatory testing in the workup of primary aldosteronism: a retrospective study in a french hypertensive population","volume":"51","author":"Vivien","year":"2019","journal-title":"Horm Metab Res."},{"key":"2021122205224296100_CIT0017","first-page":"dgz148","article-title":"Role of aldosterone and potassium levels in sparing confirmatory tests in primary aldosteronism","volume":"105(4)","author":"Umakoshi","year":"2020","journal-title":"J Clin Endocrinol Metab."},{"key":"2021122205224296100_CIT0018","first-page":"dgaa117","article-title":"Baseline plasma aldosterone level and renin activity allowing omission of confirmatory testing in primary aldosteronism","volume":"105(5)","author":"Kawashima","year":"2020","journal-title":"J Clin Endocrinol Metab."},{"issue":"3","key":"2021122205224296100_CIT0019","doi-asserted-by":"crossref","first-page":"196","DOI":"10.1111\/cen.14142","article-title":"Construction of a predictive scoring system as a guide to screening and confirmation of the diagnosis of primary aldosteronism","volume":"92","author":"Kietsiriroje","year":"2020","journal-title":"Clin Endocrinol (Oxf)."},{"issue":"4","key":"2021122205224296100_CIT0020","doi-asserted-by":"crossref","first-page":"1025","DOI":"10.1161\/HYPERTENSIONAHA.119.14063","article-title":"Prevalence of hypokalemia and primary aldosteronism in 5100 patients referred to a tertiary hypertension unit","volume":"75","author":"Burrello","year":"2020","journal-title":"Hypertension."},{"issue":"1","key":"2021122205224296100_CIT0021","doi-asserted-by":"crossref","first-page":"135","DOI":"10.1097\/HJH.0b013e32833266e3","article-title":"Effects of female sex hormones and contraceptive pill on the diagnostic work-up for primary aldosteronism","volume":"28","author":"Pizzolo","year":"2010","journal-title":"J Hypertens."},{"issue":"2","key":"2021122205224296100_CIT0022","doi-asserted-by":"crossref","first-page":"E340","DOI":"10.1210\/jc.2010-1355","article-title":"Are women more at risk of false-positive primary aldosteronism screening and unnecessary suppression testing than men?","volume":"96","author":"Ahmed","year":"2011","journal-title":"J Clin Endocrinol Metab."}],"container-title":["The Journal of Clinical Endocrinology &amp; Metabolism"],"original-title":[],"language":"en","link":[{"URL":"http:\/\/academic.oup.com\/jcem\/advance-article-pdf\/doi\/10.1210\/clinem\/dgaa974\/36218550\/dgaa974.pdf","content-type":"application\/pdf","content-version":"am","intended-application":"syndication"},{"URL":"https:\/\/academic.oup.com\/jcem\/article-pdf\/106\/4\/1708\/41849388\/dgaa974.pdf","content-type":"application\/pdf","content-version":"vor","intended-application":"syndication"},{"URL":"https:\/\/academic.oup.com\/jcem\/article-pdf\/106\/4\/1708\/41849388\/dgaa974.pdf","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2022,12,10]],"date-time":"2022-12-10T00:53:45Z","timestamp":1670633625000},"score":1,"resource":{"primary":{"URL":"https:\/\/academic.oup.com\/jcem\/article\/106\/4\/1708\/6055576"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2020,12,30]]},"references-count":22,"journal-issue":{"issue":"4","published-online":{"date-parts":[[2020,12,30]]},"published-print":{"date-parts":[[2021,3,25]]}},"URL":"https:\/\/doi.org\/10.1210\/clinem\/dgaa974","relation":{},"ISSN":["0021-972X","1945-7197"],"issn-type":[{"value":"0021-972X","type":"print"},{"value":"1945-7197","type":"electronic"}],"subject":[],"published-other":{"date-parts":[[2021,4,1]]},"published":{"date-parts":[[2020,12,30]]}}}