{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,6,8]],"date-time":"2026-06-08T14:40:48Z","timestamp":1780929648736,"version":"3.54.1"},"reference-count":28,"publisher":"Walter de Gruyter GmbH","issue":"12","license":[{"start":{"date-parts":[[2025,5,28]],"date-time":"2025-05-28T00:00:00Z","timestamp":1748390400000},"content-version":"unspecified","delay-in-days":0,"URL":"http:\/\/creativecommons.org\/licenses\/by\/4.0"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":[],"published-print":{"date-parts":[[2025,11,25]]},"abstract":"<jats:title>Abstract<\/jats:title>\n                  <jats:sec id=\"j_cclm-2025-0644_abs_001\">\n                    <jats:title>Objectives<\/jats:title>\n                    <jats:p>Primary aldosteronism (PA) is an underdiagnosed yet important condition. This study aimed to evaluate the diagnostic performance of a combined protocol using oral salt loading and postural stimulation tests (PST), named the balance study, to confirm and subtype\u00a0PA.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec id=\"j_cclm-2025-0644_abs_002\">\n                    <jats:title>Methods<\/jats:title>\n                    <jats:p>We retrospectively analyzed the data of 402 patients with either confirmed PA or essential hypertension who underwent the balance study. Biochemical markers were measured using liquid chromatography-tandem mass spectrometry. Receiver operating characteristic curves were used to assess the diagnostic performance. The cut-off values for biochemical markers were determined by Youden J\u2019s statistics.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec id=\"j_cclm-2025-0644_abs_003\">\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>For PA confirmation, urinary aldosterone (UALD; area under the curve [AUC] 0.894), urinary tetrahydroaldosterone (UTHA; AUC 0.875), the sum of UALD and UTHA (SUM; AUC 0.884), and supine plasma aldosterone (PALD; AUC\u00a00.902) showed comparable performance. Corresponding cut-offs were: UALD&gt;38\u202fnmol\/day, UTHA&gt;160\u202fnmol\/day, SUM&gt;259\u202fnmol\/day, and supine PALD&gt;273\u202fpmol\/L. For PA subtyping, the difference or ratio between erect and supine PALD in PST achieved an AUC of 0.90. An increase of less than 19\u202fpmol\/L or less than 5\u202f% from a supine to an erect position suggested an aldosterone-producing adenoma.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec id=\"j_cclm-2025-0644_abs_004\">\n                    <jats:title>Conclusions<\/jats:title>\n                    <jats:p>This combined protocol using oral salt loading and PST could help confirm a diagnosis of PA and predict the subtype. UTHA and supine PALD may add value to UALD for PA confirmation, whereas the erect\/supine PALD ratio from PST could assist in PA subtyping. Further studies are required to validate these findings.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1515\/cclm-2025-0644","type":"journal-article","created":{"date-parts":[[2025,8,8]],"date-time":"2025-08-08T07:58:06Z","timestamp":1754639886000},"page":"2485-2493","source":"Crossref","is-referenced-by-count":3,"title":["Oral salt loading combined with postural stimulation tests for confirming and subtyping primary aldosteronism"],"prefix":"10.1515","volume":"63","author":[{"given":"Jenny Yeuk Ki","family":"Cheng","sequence":"first","affiliation":[{"name":"Department of Chemical Pathology , 13621 Prince of Wales Hospital , Hong Kong , Hong Kong"},{"name":"Department of Chemical Pathology , The Chinese University of Hong Kong , Hong Kong , Hong Kong"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Wai Shan Clara","family":"Lo","sequence":"additional","affiliation":[{"name":"Department of Chemical Pathology , 13621 Prince of Wales Hospital , Hong Kong , Hong Kong"},{"name":"Department of Chemical Pathology , The Chinese University of Hong Kong , Hong Kong , Hong Kong"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Teresa Kam Chi","family":"Tsui","sequence":"additional","affiliation":[{"name":"Department of Chemical Pathology , 13621 Prince of Wales Hospital , Hong Kong , Hong Kong"},{"name":"Department of Chemical Pathology , The Chinese University of Hong Kong , Hong Kong , Hong Kong"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Wing Kar Edith","family":"Chow","sequence":"additional","affiliation":[{"name":"Department of Medicine and Therapeutics , The Chinese University of Hong Kong, Prince of Wales Hospital , Hong Kong , Hong Kong"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Kitty Kit Ting","family":"Cheung","sequence":"additional","affiliation":[{"name":"Department of Medicine and Therapeutics , The Chinese University of Hong Kong, Prince of Wales Hospital , Hong Kong , Hong Kong"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Ronald Ching Wan","family":"Ma","sequence":"additional","affiliation":[{"name":"Department of Medicine and Therapeutics , The Chinese University of Hong Kong, Prince of Wales Hospital , Hong Kong , Hong Kong"},{"name":"Hong Kong Institute of Diabetes and Obesity , The Chinese University of Hong Kong , Hong Kong , Hong Kong"},{"name":"Li Ka Shing Institute of Health Sciences , The Chinese University of Hong Kong , Hong Kong , Hong Kong"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Risa","family":"Ozaki","sequence":"additional","affiliation":[{"name":"Department of Medicine and Therapeutics , The Chinese University of Hong Kong, Prince of Wales Hospital , Hong Kong , Hong Kong"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Chung Shun","family":"Ho","sequence":"additional","affiliation":[{"name":"Department of Chemical Pathology , The Chinese University of Hong Kong , Hong Kong , Hong Kong"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"374","published-online":{"date-parts":[[2025,5,28]]},"reference":[{"key":"2025110712102438765_j_cclm-2025-0644_ref_001","doi-asserted-by":"crossref","unstructured":"Yozamp, N, Vaidya, A. The prevalence of primary aldosteronism and evolving approaches for treatment. Curr Opin Endocr Metab Res 2019;8:30\u20139. https:\/\/doi.org\/10.1016\/j.coemr.2019.07.001.","DOI":"10.1016\/j.coemr.2019.07.001"},{"key":"2025110712102438765_j_cclm-2025-0644_ref_002","doi-asserted-by":"crossref","unstructured":"Vaidya, A, Mulatero, P, Baudrand, R, Adler, GK. The expanding spectrum of primary aldosteronism: implications for diagnosis, pathogenesis, and treatment. Endocr Rev 2018;39:1057\u201388. https:\/\/doi.org\/10.1210\/er.2018-00139.","DOI":"10.1210\/er.2018-00139"},{"key":"2025110712102438765_j_cclm-2025-0644_ref_003","doi-asserted-by":"crossref","unstructured":"Hernandez, MF, Bhalla, V. Underdiagnosis of primary aldosteronism: a review of screening and detection. Am J Kidney Dis 2023;82:333\u201346. https:\/\/doi.org\/10.1053\/j.ajkd.2023.01.447.","DOI":"10.1053\/j.ajkd.2023.01.447"},{"key":"2025110712102438765_j_cclm-2025-0644_ref_004","doi-asserted-by":"crossref","unstructured":"Williams, TA, Lenders, JWM, Mulatero, P, Burrello, J, Rottenkolber, M, Adolf, C, et al.. Outcomes after adrenalectomy for unilateral primary aldosteronism: an international consensus on outcome measures and analysis of remission rates in an international cohort. Lancet Diabetes Endocrinol 2017;5:689\u201399. https:\/\/doi.org\/10.1016\/s2213-8587-17-30135-3.","DOI":"10.1016\/S2213-8587(17)30135-3"},{"key":"2025110712102438765_j_cclm-2025-0644_ref_005","doi-asserted-by":"crossref","unstructured":"Hundemer, GL, Curhan, GC, Yozamp, N, Wang, M, Vaidya, A. Cardiometabolic outcomes and mortality in medically treated primary aldosteronism: a retrospective cohort study. Lancet Diabetes Endocrinol 2018;6:51\u20139. https:\/\/doi.org\/10.1016\/s2213-8587-17-30367-4.","DOI":"10.1016\/S2213-8587(17)30367-4"},{"key":"2025110712102438765_j_cclm-2025-0644_ref_006","doi-asserted-by":"crossref","unstructured":"Funder, JW, Carey, RM, Mantero, F, Murad, MH, Reincke, M, Shibata, H, et al.. The management of primary aldosteronism: case detection, diagnosis, and treatment: an endocrine society clinical practice guideline. J\u00a0Clin Endocrinol Metabol 2016;101:1889\u2013916. https:\/\/doi.org\/10.1210\/jc.2015-4061.","DOI":"10.1210\/jc.2015-4061"},{"key":"2025110712102438765_j_cclm-2025-0644_ref_007","doi-asserted-by":"crossref","unstructured":"Rossi, GP, Rossitto, G, Amar, L, Azizi, M, Riester, A, Reincke, M, et al.. Clinical outcomes of 1625 patients with primary aldosteronism subtyped with adrenal vein sampling. Hypertension 2019;74:800\u20138. https:\/\/doi.org\/10.1161\/hypertensionaha.119.13463.","DOI":"10.1161\/HYPERTENSIONAHA.119.13463"},{"key":"2025110712102438765_j_cclm-2025-0644_ref_008","doi-asserted-by":"crossref","unstructured":"Grundy, M, Leung, AA, Hyrcza, M, Pasieka, JL, Chan, D, Przybojewski, SJ, et al.. Discordance between adrenal vein sampling and imaging: the role of unilateral cortisol excess. Eur J Endocrinol 2025;192:191\u2013201. https:\/\/doi.org\/10.1093\/ejendo\/lvaf019.","DOI":"10.1093\/ejendo\/lvaf019"},{"key":"2025110712102438765_j_cclm-2025-0644_ref_009","doi-asserted-by":"crossref","unstructured":"Heinze, B, Fuss, CT, Mulatero, P, Beuschlein, F, Reincke, M, Mustafa, M, et al.. Targeting CXCR4 (CXC chemokine receptor type 4) for molecular imaging of aldosterone-producing adenoma. Hypertension 2018;71:317\u201325. https:\/\/doi.org\/10.1161\/hypertensionaha.117.09975.","DOI":"10.1161\/HYPERTENSIONAHA.117.09975"},{"key":"2025110712102438765_j_cclm-2025-0644_ref_010","doi-asserted-by":"crossref","unstructured":"Abe, T, Naruse, M, Young, WF, Kobashi, N, Doi, Y, Izawa, A, et al.. A novel CYP11B2-specific imaging agent for detection of unilateral subtypes of primary aldosteronism. J\u00a0Clin Endocrinol Metab 2016;101:1008\u201315. https:\/\/doi.org\/10.1210\/jc.2015-3431.","DOI":"10.1210\/jc.2015-3431"},{"key":"2025110712102438765_j_cclm-2025-0644_ref_011","doi-asserted-by":"crossref","unstructured":"O\u2019Shea, PM, O\u2019Donoghue, D, Bashari, W, Senanayake, R, Joyce, MB, Powlson, AS, et al.. 11\u00a0C-Metomidate PET\/CT is a useful adjunct for lateralization of primary aldosteronism in routine clinical practice. Clin Endocrinol (Oxf) 2019;90:670\u20139. https:\/\/doi.org\/10.1111\/cen.13942.","DOI":"10.1111\/cen.13942"},{"key":"2025110712102438765_j_cclm-2025-0644_ref_012","doi-asserted-by":"crossref","unstructured":"Wu, MH, Liu, FH, Lin, KJ, Sun, JH, Chen, ST. Diagnostic value of adrenal iodine-131 6-beta-iodomethyl-19-norcholesterol scintigraphy for primary aldosteronism: a retrospective study at a medical center in North Taiwan. Nucl Med Commun 2019;40:568\u201375. https:\/\/doi.org\/10.1097\/mnm.0000000000000987.","DOI":"10.1097\/MNM.0000000000000987"},{"key":"2025110712102438765_j_cclm-2025-0644_ref_013","doi-asserted-by":"crossref","unstructured":"Eisenhofer, G, Dur\u00e1n, C, Cannistraci, CV, Peitzsch, M, Williams, TA, Riester, A, et al.. Use of steroid profiling combined with machine learning for identification and subtype classification in primary aldosteronism. JAMA Netw Open 2020;3:e2016209. https:\/\/doi.org\/10.1001\/jamanetworkopen.2020.16209.","DOI":"10.1001\/jamanetworkopen.2020.16209"},{"key":"2025110712102438765_j_cclm-2025-0644_ref_014","doi-asserted-by":"crossref","unstructured":"Feltynowski, T, Ignatowska\u2010Switaiska, H, Woclal, B, Lewandowski, J, Chodakowska, J, Januszewicz, W. Postural stimulation test in patients with aldosterone producing adenomas. Clin Endocrinol (Oxf) 1994;41:309\u201314. https:\/\/doi.org\/10.1111\/j.1365-2265.1994.tb02550.x.","DOI":"10.1111\/j.1365-2265.1994.tb02550.x"},{"key":"2025110712102438765_j_cclm-2025-0644_ref_015","doi-asserted-by":"crossref","unstructured":"Dekkers, T, Prejbisz, A, Kool, LJS, Groenewoud, HJMM, Velema, M, Spiering, W, et al.. Adrenal vein sampling versus CT scan to determine treatment in primary aldosteronism: an outcome-based randomised diagnostic trial. Lancet Diabetes Endocrinol 2016;4:739\u201346. https:\/\/doi.org\/10.1016\/s2213-8587-16-30100-0.","DOI":"10.1016\/S2213-8587(16)30100-0"},{"key":"2025110712102438765_j_cclm-2025-0644_ref_016","doi-asserted-by":"crossref","unstructured":"Wu, X, Senanayake, R, Goodchild, E, Bashari, WA, Salsbury, J, Cabrera, CP, et al.. [11C]metomidate PET-CT versus adrenal vein sampling for diagnosing surgically curable primary aldosteronism: a prospective, within-patient trial. Nat Med 2023;29:190\u2013202. https:\/\/doi.org\/10.1038\/s41591-022-02114-5.","DOI":"10.1038\/s41591-022-02114-5"},{"key":"2025110712102438765_j_cclm-2025-0644_ref_017","doi-asserted-by":"crossref","unstructured":"Ganguly, A, Melada, GA, Luetscher, JA, Dowdy, AJ. Control of plasma aldosterone in primary aldosteronism: distinction between adenoma and hyperplasia. J\u00a0Clin Endocrinol Metab 1973;37:765\u201375. https:\/\/doi.org\/10.1210\/jcem-37-5-765.","DOI":"10.1210\/jcem-37-5-765"},{"key":"2025110712102438765_j_cclm-2025-0644_ref_018","doi-asserted-by":"crossref","unstructured":"Lau, JHG, Candy Sze, WC, Reznek, RH, Matson, M, Sahdev, A, Carpenter, R, et al.. A prospective evaluation of postural stimulation testing, computed tomography and adrenal vein sampling in the differential diagnosis of primary aldosteronism. Clin Endocrinol (Oxf) 2012;76:182\u20138. https:\/\/doi.org\/10.1111\/j.1365-2265.2011.04202.x.","DOI":"10.1111\/j.1365-2265.2011.04202.x"},{"key":"2025110712102438765_j_cclm-2025-0644_ref_019","doi-asserted-by":"crossref","unstructured":"Wu, Y, Wu, Z, Hu, H, Rao, J, Hu, C, Peng, Q, et al.. Significance of computed tomography combined with postural stimulation test in predicting laterality of primary aldosteronism. BMC Endocr Disord 2023;23:32. https:\/\/doi.org\/10.1186\/s12902-023-01281-x.","DOI":"10.1186\/s12902-023-01281-x"},{"key":"2025110712102438765_j_cclm-2025-0644_ref_020","doi-asserted-by":"crossref","unstructured":"Fuss, CT, Brohm, K, Fassnacht, M, Kroiss, M, Hahner, S. Reassessment of postural stimulation testing as a simple tool to identify a subgroup of patients with unilateral primary aldosteronism. J\u00a0Clin Endocrinol Metab 2022;107:e865\u201373. https:\/\/doi.org\/10.1210\/clinem\/dgab611.","DOI":"10.1210\/clinem\/dgab611"},{"key":"2025110712102438765_j_cclm-2025-0644_ref_021","doi-asserted-by":"crossref","unstructured":"Abdelhamid, S, Blomer, R, Hommel, G, Haack, D, Lewicka, S, Fiegel, P, et al.. Urinary tetrahydroaldosterone as a screening method for primary aldosteronism: a comparative study. Am J Hypertens 2003;16:522\u201330. https:\/\/doi.org\/10.1016\/s0895-7061-03-00858-6.","DOI":"10.1016\/S0895-7061(03)00858-6"},{"key":"2025110712102438765_j_cclm-2025-0644_ref_022","doi-asserted-by":"crossref","unstructured":"Cheng, JYK, Lo, CWS, Chan, ASL, Luk, YK, Tsui, TKC, Ho, CS. Simultaneous quantitation of urine aldosterone and tetrahydroaldosterone in healthy Chinese subjects using a validated LC\u2013MS\/MS method. Biomed Chromatogr 2023;37:e5694. https:\/\/doi.org\/10.1002\/bmc.5694.","DOI":"10.1002\/bmc.5694"},{"key":"2025110712102438765_j_cclm-2025-0644_ref_023","doi-asserted-by":"crossref","unstructured":"Zeng, W, Chu, TTW, Ho, CS, Lo, CWS, Chan, ASL, Kong, APS, et al.. Lack of effects of renin-angiotensin-aldosterone system activity and beta-adrenoceptor pathway polymorphisms on the response to bisoprolol in hypertension. Front Cardiovasc Med 2022;9:842875. https:\/\/doi.org\/10.3389\/fcvm.2022.842875.","DOI":"10.3389\/fcvm.2022.842875"},{"key":"2025110712102438765_j_cclm-2025-0644_ref_024","doi-asserted-by":"crossref","unstructured":"Leung, AA, Symonds, CJ, Hundemer, GL, Ronksley, PE, Lorenzetti, DL, Pasieka, JL, et al.. Performance of confirmatory tests for diagnosing primary aldosteronism: a systematic review and meta-analysis. Hypertension 2022;79:1835\u201344. https:\/\/doi.org\/10.1161\/hypertensionaha.122.19377.","DOI":"10.1161\/HYPERTENSIONAHA.122.19377"},{"key":"2025110712102438765_j_cclm-2025-0644_ref_025","doi-asserted-by":"crossref","unstructured":"Fontes, RG, Kater, CE, Biglieri, EG, Irony, I. Reassessment of the predictive value of the postural stimulation test in primary aldosteronism. Am J Hypertens 1991;4:786\u201391. https:\/\/doi.org\/10.1093\/ajh\/4.9.786.","DOI":"10.1093\/ajh\/4.9.786"},{"key":"2025110712102438765_j_cclm-2025-0644_ref_026","doi-asserted-by":"crossref","unstructured":"Eisenhofer, G, Kurlbaum, M, Peitzsch, M, Constantinescu, G, Remde, H, Schulze, M, et al.. The saline infusion test for primary aldosteronism: implications of immunoassay inaccuracy. J\u00a0Clin Endocrinol Metab 2022;107:e2027\u201336. https:\/\/doi.org\/10.1210\/clinem\/dgab924.","DOI":"10.1210\/clinem\/dgab924"},{"key":"2025110712102438765_j_cclm-2025-0644_ref_027","doi-asserted-by":"crossref","unstructured":"Sheaves, R, Goldin, J, Reznek, RH, Chew, SL, Dacie, JE, Lowe, DG, et al.. Relative value of computed tomography scanning and venous sampling in establishing the cause of primary hyperaldosteronism. Eur J Endocrinol 1996;134:308\u201313. https:\/\/doi.org\/10.1530\/eje.0.1340308.","DOI":"10.1530\/eje.0.1340308"},{"key":"2025110712102438765_j_cclm-2025-0644_ref_028","doi-asserted-by":"crossref","unstructured":"St-Jean, M, Bourdeau, I, Martin, M, Lacroix, A. Aldosterone is aberrantly regulated by various stimuli in a high proportion of patients with primary aldosteronism. J\u00a0Clin Endocrinol Metab 2021;106:e45\u201360. https:\/\/doi.org\/10.1210\/clinem\/dgaa703.","DOI":"10.1210\/clinem\/dgaa703"}],"container-title":["Clinical Chemistry and Laboratory Medicine (CCLM)"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/www.degruyterbrill.com\/document\/doi\/10.1515\/cclm-2025-0644\/xml","content-type":"application\/xml","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/www.degruyterbrill.com\/document\/doi\/10.1515\/cclm-2025-0644\/pdf","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2025,11,7]],"date-time":"2025-11-07T12:12:15Z","timestamp":1762517535000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.degruyterbrill.com\/document\/doi\/10.1515\/cclm-2025-0644\/html"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2025,5,28]]},"references-count":28,"journal-issue":{"issue":"12","published-online":{"date-parts":[[2025,9,16]]},"published-print":{"date-parts":[[2025,11,25]]}},"alternative-id":["10.1515\/cclm-2025-0644"],"URL":"https:\/\/doi.org\/10.1515\/cclm-2025-0644","relation":{},"ISSN":["1434-6621","1437-4331"],"issn-type":[{"value":"1434-6621","type":"print"},{"value":"1437-4331","type":"electronic"}],"subject":[],"published":{"date-parts":[[2025,5,28]]}}}