{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,9,18]],"date-time":"2026-09-18T02:18:13Z","timestamp":1789697893698,"version":"4.0.1"},"reference-count":28,"publisher":"The Endocrine Society","issue":"3","license":[{"start":{"date-parts":[[2019,11,2]],"date-time":"2019-11-02T00:00:00Z","timestamp":1572652800000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/academic.oup.com\/journals\/pages\/open_access\/funder_policies\/chorus\/standard_publication_model"}],"funder":[{"name":"Irene Patricia Hunt Memorial Trust"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":[],"published-print":{"date-parts":[[2020,3,1]]},"abstract":"<jats:title>Abstract<\/jats:title>\n               <jats:sec>\n                  <jats:title>Background<\/jats:title>\n                  <jats:p>In primary aldosteronism (PA), excessive, autonomous secretion of aldosterone is not suppressed by salt loading or fludrocortisone. For seated saline suppression testing (SSST), the recommended diagnostic cutoff 4-hour plasma aldosterone concentration (PAC) measured by high-performance liquid chromatography\u2013mass spectrometry (HPLC-MS\/MS is 162 pmol\/L. Most diagnostic laboratories, however, use immunoassays to measure PAC. The cutoff for SSST using immunoassay is not known. We hypothesized that the cutoff is different between the assays.<\/jats:p>\n               <\/jats:sec>\n               <jats:sec>\n                  <jats:title>Methods<\/jats:title>\n                  <jats:p>We analyzed 80 of the 87 SSST tests that were performed during our recent study defining the HPLC-MS\/MS cutoff. PA was confirmed in 65 by positive fludrocortisone suppression testing (FST) and\/or lateralization on adrenal venous sampling and excluded in 15 by negative FST. PAC was measured by a chemiluminescence immunoassay (PACIA) in the SSST samples using the DiaSorin Liaison XL analyzer, and receiver operating characteristics (ROC) analysis was performed to identify the PACIA cutoff.<\/jats:p>\n               <\/jats:sec>\n               <jats:sec>\n                  <jats:title>Results<\/jats:title>\n                  <jats:p>ROC revealed good performance (area under the curve = 0.893; P &amp;lt; .001) of 4-hour postsaline PACIA for diagnosis of PA and an optimal diagnostic cutoff of 171 pmol\/L, with sensitivity and specificity of 95.4% and 80.0%, respectively. A higher cutoff of 217 pmol\/L improved specificity (86.7%) with lower sensitivity (86.2%). PACIA measurements strongly correlated with PAC measured by HPLC-MS (r = 0.94, P &amp;lt; .001).<\/jats:p>\n               <\/jats:sec>\n               <jats:sec>\n                  <jats:title>Conclusions<\/jats:title>\n                  <jats:p>A higher diagnostic cutoff for SSST should be employed when PAC is measured by immunoassay rather than HPLC-MS\/MS. The results suggest that (i) PA can be excluded if 4-hour PACIA is less than 171 pmol\/L, and (ii) PA is highly likely if the PACIA is greater than 217 pmol\/L by chemiluminescence immunoassay. A gray zone exists between the cutoffs of 171 and 217 pmol\/L, likely reflecting a lower specificity of immunoassay.<\/jats:p>\n               <\/jats:sec>","DOI":"10.1210\/clinem\/dgz150","type":"journal-article","created":{"date-parts":[[2019,11,2]],"date-time":"2019-11-02T04:39:40Z","timestamp":1572669580000},"page":"e477-e483","source":"Crossref","is-referenced-by-count":79,"title":["Diagnosis of Primary Aldosteronism by Seated Saline Suppression Test\u2014Variability Between Immunoassay and HPLC-MS\/MS"],"prefix":"10.1210","volume":"105","author":[{"given":"Moe","family":"Thuzar","sequence":"first","affiliation":[{"name":"Endocrine Hypertension Research Centre, University of Queensland Diamantina Institute, Princess Alexandra Hospital, Brisbane, Australia"},{"name":"Department of Endocrinology, Princess Alexandra Hospital, Brisbane, Australia"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Karen","family":"Young","sequence":"additional","affiliation":[{"name":"Department of Chemical Pathology, Sullivan Nicolaides Laboratories, Brisbane, Australia"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Ashraf H","family":"Ahmed","sequence":"additional","affiliation":[{"name":"Endocrine Hypertension Research Centre, University of Queensland Diamantina Institute, Princess Alexandra Hospital, Brisbane, Australia"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Greg","family":"Ward","sequence":"additional","affiliation":[{"name":"Department of Chemical Pathology, Sullivan Nicolaides Laboratories, Brisbane, Australia"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Martin","family":"Wolley","sequence":"additional","affiliation":[{"name":"Endocrine Hypertension Research Centre, University of Queensland Diamantina Institute, Princess Alexandra Hospital, Brisbane, Australia"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Zeng","family":"Guo","sequence":"additional","affiliation":[{"name":"Endocrine Hypertension Research Centre, University of Queensland Diamantina Institute, Princess Alexandra Hospital, Brisbane, Australia"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Richard D","family":"Gordon","sequence":"additional","affiliation":[{"name":"Endocrine Hypertension Research Centre, University of Queensland Diamantina Institute, Princess Alexandra Hospital, Brisbane, Australia"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Brett C","family":"McWhinney","sequence":"additional","affiliation":[{"name":"Department of Chemical Pathology, Pathology Queensland, Brisbane, Australia"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Jacobus P","family":"Ungerer","sequence":"additional","affiliation":[{"name":"Department of Chemical Pathology, Pathology Queensland, Brisbane, Australia"},{"name":"Faculty of Biomedical Science, University of Queensland, Brisbane, Australia"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-4317-8584","authenticated-orcid":false,"given":"Michael","family":"Stowasser","sequence":"additional","affiliation":[{"name":"Endocrine Hypertension Research Centre, University of Queensland Diamantina Institute, Princess Alexandra Hospital, Brisbane, Australia"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"80","published-online":{"date-parts":[[2019,11,2]]},"reference":[{"issue":"11","key":"2021122102221309700_CIT0001","doi-asserted-by":"crossref","first-page":"2149","DOI":"10.1097\/00004872-200311000-00025","article-title":"High rate of detection of primary aldosteronism, including surgically treatable forms, after \u2018non-selective\u2019 screening of hypertensive patients","volume":"21","author":"Stowasser","year":"2003","journal-title":"J Hypertens."},{"issue":"5","key":"2021122102221309700_CIT0002","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":"3","key":"2021122102221309700_CIT0003","doi-asserted-by":"crossref","first-page":"1045","DOI":"10.1210\/jc.2003-031337","article-title":"Increased diagnosis of primary aldosteronism, including surgically correctable forms, in centers from five continents","volume":"89","author":"Mulatero","year":"2004","journal-title":"J Clin Endocrinol Metab."},{"issue":"11","key":"2021122102221309700_CIT0004","doi-asserted-by":"crossref","first-page":"2293","DOI":"10.1016\/j.jacc.2006.07.059","article-title":"A prospective study of the prevalence of primary aldosteronism in 1,125 hypertensive 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