{"@context":"https://schema.org","@type":"ScholarlyArticle","headline":"Seated Saline Suppression Test for Lateralizing Primary Aldosteronism.","author":[{"@type":"Person","name":"Alexander A Leung"},{"@type":"Person","name":"Raj S Padwal"},{"@type":"Person","name":"Gregory L Hundemer"},{"@type":"Person","name":"Erik Venos"},{"@type":"Person","name":"David J T Campbell"},{"@type":"Person","name":"Daniel T Holmes"},{"@type":"Person","name":"Dennis J Orton"},{"@type":"Person","name":"C Benny So"},{"@type":"Person","name":"Stefan J Przybojewski"},{"@type":"Person","name":"Cori E Caughlin"},{"@type":"Person","name":"Janice L Pasieka"},{"@type":"Person","name":"Doreen M Rabi"},{"@type":"Person","name":"Gregory A Kline"}],"datePublished":"2026","isPartOf":{"@type":"Periodical","name":"Hypertension (Dallas, Tex. : 1979)"},"identifier":"https://doi.org/10.1161/HYPERTENSIONAHA.125.26008","description":"\n BACKGROUND:\n Confirmatory testing to identify lateralizing primary aldosteronism (PA) is of uncertain benefit.\n \n \n METHODS:\n Blinded clinical trial where patients with high-risk features for PA underwent the seated saline suppression test (SSST). All patients received adrenal vein sampling, where lateralization was defined by an aldosterone/cortisol ratio ≥3:1 comparing the dominant versus the nondominant sides. The primary outcome was the overall diagnostic accuracy of the SSST in identifying lateralizing PA using postinfusion aldosterone concentrations of ≥140 pmol/L (5.0 ng/dL) and ≥280 pmol/L (10.1 ng/dL) with immunoassay, and ≥162 pmol/L (5.8 ng/dL) with liquid chromatography/tandem mass spectrometry.\n \n \n RESULTS:\n A total of 160 patients completed the trial. Lateralizing PA was diagnosed in 98 patients (61.3%). The overall diagnostic accuracy of the SSST using an aldosterone cutoff of ≥140 pmol/L (5.0 ng/dL) and ≥280 pmol/L (10.1 ng/dL) was 64.4% (95% CI, 56.4–71.8) and 67.5% (95% CI, 59.7–74.7), respectively. A positive result was equivocal at the lower cutoff of ≥140 pmol/L (5.0 ng/dL; positive likelihood ratio, 1.1 [95% CI, 1.0–1.3]) and minimally informative at the higher cutoff of ≥280 pmol/L (10.1 ng/dL; positive likelihood ratio, 1.9 [95% CI, 1.3–2.7]). Negative results modestly ruled against lateralization using cutoffs of ≥140 pmol/L (5.0 ng/dL) and ≥280 pmol/L (10.1 ng/dL; negative likelihood ratio, 0.3 [95% CI, 0.1–0.9]; and 0.5 [95% CI, 0.3–0.7], respectively). The SSST properties were similar with liquid chromatography/tandem mass spectrometry.\n \n \n CONCLUSIONS:\n Aldosterone suppression testing is unreliable for anticipating adrenal vein sampling outcomes. The SSST may misinform diagnostic-treatment decisions.\n \n \n REGISTRATION:\n \n URL:\n https://www.clinicaltrials.gov\n ; Unique identifier: NCT04422756.\n \n ","url":"https://innscience.ca/en/community/literature/doi_10_1161_hypertensionaha_125_26008"}