{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,8,21]],"date-time":"2026-08-21T16:41:14Z","timestamp":1787330474970,"version":"build-2736575974"},"reference-count":33,"publisher":"The Endocrine Society","license":[{"start":{"date-parts":[[2026,8,10]],"date-time":"2026-08-10T00:00:00Z","timestamp":1786320000000},"content-version":"am","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"funder":[{"DOI":"10.13039\/501100003725","name":"National Research Foundation of Korea","doi-asserted-by":"publisher","award":["2020R1F1A1074265"],"award-info":[{"award-number":["2020R1F1A1074265"]}],"id":[{"id":"10.13039\/501100003725","id-type":"DOI","asserted-by":"publisher"}]},{"DOI":"10.13039\/501100003725","name":"National Research Foundation of Korea","doi-asserted-by":"publisher","award":["RS-2025-00562220"],"award-info":[{"award-number":["RS-2025-00562220"]}],"id":[{"id":"10.13039\/501100003725","id-type":"DOI","asserted-by":"publisher"}]},{"DOI":"10.13039\/501100002642","name":"Korea University","doi-asserted-by":"publisher","award":["K2603631"],"award-info":[{"award-number":["K2603631"]}],"id":[{"id":"10.13039\/501100002642","id-type":"DOI","asserted-by":"publisher"}]}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":[],"abstract":"<jats:title>Abstract<\/jats:title>\n                  <jats:sec>\n                    <jats:title>Context<\/jats:title>\n                    <jats:p>Confirmatory aldosterone suppression testing is widely utilized following positive screening for primary aldosteronism (PA), yet its incremental diagnostic value remains debated. While the 2025 Endocrine Society guideline proposes a probability-based approach, validated tools to translate this concept into clinical decision-making, particularly in Asian populations, are lacking.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods<\/jats:title>\n                    <jats:p>Using a multicenter common data model across 3 tertiary hospitals (2002-2020), we retrospectively identified 307 patients who underwent saline infusion test (SIT) for suspected PA. Saline infusion test positivity was defined as postinfusion plasma aldosterone concentration (PAC) \u2265 10\u2005ng\/dL. We developed a conditional inference classification tree using screening-stage variables and compared its performance with conventional rigid screening criteria based on PAC and the aldosterone-to-renin ratio.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>Among 307 patients (mean age 51.2 years), 153 (49.8%) were SIT positive. Saline infusion test-positive patients had higher PAC (median 32.9 vs 12.7\u2005ng\/dL, P &amp;lt; 0.001) and lower serum potassium levels (3.66 vs 4.02\u2005mmol\/L, P &amp;lt; .001). The decision tree identified a high-probability phenotype defined by PAC &amp;gt; 25\u2005ng\/dL and plasma renin activity \u2264 0.55\u2005ng\/mL\/h, with an SIT positivity rate of 96.4%. In patients with a PAC of 15.7 to 25.0\u2005ng\/dL, potassium \u2264 3.9\u2005mmol\/L further stratified SIT positivity to 68.8%, whereas patients with PAC \u2264 15.7\u2005ng\/dL had a low positivity rate. The tree-derived criteria outperformed conventional cutoffs, with an accuracy of 0.85, a sensitivity of 0.83, and a specificity of 0.86, and performance remained robust in internal validation and sensitivity analyses.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusion<\/jats:title>\n                    <jats:p>A screening-stage decision tree provides clinically interpretable probabilities for SIT positivity, supporting risk-stratified confirmatory testing and selective omission in high-probability patients.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1210\/clinem\/dgag325","type":"journal-article","created":{"date-parts":[[2026,8,7]],"date-time":"2026-08-07T11:17:04Z","timestamp":1786101424000},"source":"Crossref","is-referenced-by-count":1,"title":["Decision tree prediction of saline infusion test outcomes in suspected primary aldosteronism: a multicenter common data model study"],"prefix":"10.1210","author":[{"given":"Kyoung Jin","family":"Kim","sequence":"first","affiliation":[{"name":"Division of Endocrinology and Metabolism, Department of Internal Medicine, Korea University Anam Hospital, Korea University College of Medicine , Seoul 02841 ,","place":["Republic of Korea"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-2834-2718","authenticated-orcid":false,"given":"Jimi","family":"Choi","sequence":"additional","affiliation":[{"name":"Division of Endocrinology and Metabolism, Department of Internal Medicine, Korea University Anam Hospital, Korea University College of Medicine , Seoul 02841 ,","place":["Republic of Korea"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Namyoung","family":"Baek","sequence":"additional","affiliation":[{"name":"Institute for Human Genomic Study, Korea University Ansan Hospital , Ansan 15355 ,","place":["Republic of Korea"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Min Jeong","family":"Park","sequence":"additional","affiliation":[{"name":"Division of Endocrinology and Metabolism, Department of Internal Medicine, Korea University Guro Hospital, Korea University College of Medicine , Seoul 08308 ,","place":["Republic of Korea"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Eyun","family":"Song","sequence":"additional","affiliation":[{"name":"Division of Endocrinology and Metabolism, Department of Internal Medicine, Korea University Guro Hospital, Korea University College of Medicine , Seoul 08308 ,","place":["Republic of Korea"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"So Young","family":"Park","sequence":"additional","affiliation":[{"name":"Division of Endocrinology and Metabolism, Department of Internal Medicine, Korea University Ansan Hospital, Korea University College of Medicine , Ansan 15355 ,","place":["Republic of Korea"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Da Young","family":"Lee","sequence":"additional","affiliation":[{"name":"Division of Endocrinology and Metabolism, Department of Internal Medicine, Korea University Ansan Hospital, Korea University College of Medicine , Ansan 15355 ,","place":["Republic of Korea"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Kyeong Jin","family":"Kim","sequence":"additional","affiliation":[{"name":"Division of Endocrinology and Metabolism, Department of Internal Medicine, Korea University Anam Hospital, Korea University College of Medicine , Seoul 02841 ,","place":["Republic of Korea"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Nam Hoon","family":"Kim","sequence":"additional","affiliation":[{"name":"Division of Endocrinology and Metabolism, Department of Internal Medicine, Korea University Anam Hospital, Korea University College of Medicine , Seoul 02841 ,","place":["Republic of Korea"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Hye Jin","family":"Yoo","sequence":"additional","affiliation":[{"name":"Division of Endocrinology and Metabolism, Department of Internal Medicine, Korea University Guro Hospital, Korea University College of Medicine , Seoul 08308 ,","place":["Republic of Korea"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Ji A","family":"Seo","sequence":"additional","affiliation":[{"name":"Division of Endocrinology and Metabolism, Department of Internal Medicine, Korea University Ansan Hospital, Korea University College of Medicine , Ansan 15355 ,","place":["Republic of Korea"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-7430-3675","authenticated-orcid":false,"given":"Sin Gon","family":"Kim","sequence":"additional","affiliation":[{"name":"Division of Endocrinology and Metabolism, Department of Internal Medicine, Korea University Anam Hospital, Korea University College of Medicine , Seoul 02841 ,","place":["Republic of Korea"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Kyung Mook","family":"Choi","sequence":"additional","affiliation":[{"name":"Division of Endocrinology and Metabolism, Department of Internal Medicine, Korea University Guro Hospital, Korea University College of Medicine , Seoul 08308 ,","place":["Republic of Korea"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Nan Hee","family":"Kim","sequence":"additional","affiliation":[{"name":"Division of Endocrinology and Metabolism, Department of Internal Medicine, Korea University Ansan Hospital, Korea University College of Medicine , Ansan 15355 ,","place":["Republic of Korea"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-1907-2859","authenticated-orcid":false,"given":"Ji Hee","family":"Yu","sequence":"additional","affiliation":[{"name":"Division of Endocrinology and Metabolism, Department of 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