Discordance and shortcomings of aldosterone suppression tests in primary aldosteronism
Authors' conclusion
Well-established aldosterone suppression tests for PA demonstrated substantial inconsistency, false-negative interpretations, and the inability to reliably predict lateralization outcomes in PA. Aldosterone suppression testing, using SST and CCT, lack accuracy for the diagnosis and subtyping of PA in high-risk patients.
Study context
- Population
- Patients with high-probability features of primary aldosteronism (PA) who underwent both saline suppression test (SST) and captopril challenge test (CCT)
- Participants
- 531 patients
- Comparison
- SST vs CCT
- Outcome
- Diagnostic accuracy, consistency and ability to predict unilateral PA of SST and CCT
Methodological detailsAdrenal lateralization and surgical decisions guided by individualized clinical judgment rather than SST/CCT results
- Adrenal lateralization and surgical decisions guided by individualized clinical judgment rather than SST/CCT results
Performance
As reported in the abstract
Rate of PA diagnosis by SST and CCT criteria
47.8% to 97.2%
Discordance rates between SST and CCT
10.9% to 51.6%
Further findings
Negative SST or CCT among patients with lateralizing PA
- Either a negative SST or CCT interpretation
- 6.6% to 27.9%
Negative tests among patients with PASO-defined biochemical cure after unilateral adrenalectomy
- Either a negative SST or CCT
- 4.1% to 39.8%
- False-negative results on both tests
- up to 5.1%
Original publication
Discordance and shortcomings of aldosterone suppression tests in primary aldosteronism. Eur J Endocrinol. Published 12 August 2025. doi:10.
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