Confirmatory Testing for Primary Aldosteronism : A Study of Diagnostic Test Accuracy
An erratum to this article was published (Ann Intern Med, Aug 2026 ↗)
Authors' conclusion
The SSST is associated with a high false-negative rate, and reliance on it may lead to missed opportunities for intervention.
Study context
- Population
- Adults with a positive screening result for primary aldosteronism (PA), regional Endocrine Hypertension Clinic, Calgary, Canada; Seated saline suppression test (SSST): 2 L 0.9% sodium chloride IV over 4 hours, seated
- Participants
- 156 adults
- Comparison
- Post-SSST aldosterone in treatment responders vs nonresponders
- Outcome
- Diagnostic accuracy of the SSST (sensitivity, specificity, PPV, NPV) vs treatment response (BP lowering, reduced antihypertensive dose, normalized biochemistry)
Methodological detailsblinded assessment, single-centre, Limitation: many patients with high-risk features of PA and few nonresponders
- Blinded assessment
- Single-centre
- Limitation: many patients with high-risk features of PA and few nonresponders
Performance
As reported in the abstract
Post-SSST aldosterone (immunoassay)
- SSST discrimination between response statuses, AUC
- 62.1% (95% CI 45.1% to 79.1%)
Further findings
Sensitivity analyses
- Findings consistent after accounting for treatment differences, hypokalemia and laboratory assay
Original publication
Confirmatory Testing for Primary Aldosteronism : A Study of Diagnostic Test Accuracy. Ann Intern Med. Published 6 May 2025. doi:10.
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