Further evaluation of saline infusion for the diagnosis of primary aldosteronism

O. Bryan Holland, Helle Brown, La Von Kuhnert, Carol Fairchild, Martin Risk, Celso E. Gomez-Sanchez

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128 Scopus citations


Normal subjects, normal-renin hypertensive patients, and low-renin hypertensive patients were evaluated by intravenous saline infusion and with a fludrocortisone acetate (Florinef) protocol to clarify diagnostic criteria for primary aldosteronism that are recommended for the saline infusion protocol. The patients consumed a 200 mEq sodium, 70 mEq potassium diet for 6 days, and on the last 3 days received Florinef 0.5 mg orally twice daily. On Days 3 and 6, urinary aldosterone and tetrahydroaldosterone excretions were determined, and on Days 4 and 7 plasma aldosterone (PA) was determined at 0600 after overnight recumbency and at 0800 after 2 hours of walking. Although the level of normal PA suppression by saline infusion has been commonly defined as 10 ng/dl, a value of 5 ng/dl was originally recommended. In 20 normal subjects and 45 normal-renin hypertensive patients, we found that the PA was almost always suppressed below 5 ng/dl. In 18 of 75 low-renin patients including five with aldosterone-producing adenoma (APA), the PA was never suppressed below 10 ng/dl; thus, these 18 patients had classical primary aldosteronism by generally accepted criteria. The Florinef protocol was performed in eight of these 18 patients and was abnormal in all. An abnormal Florinef protocol was also found in seven of 15 patients studied with PA suppression after saline infusion to between 5 and 10 ng/dl, but in only one of 24 patients studied with PA suppression below 5 ng/dl. Additional studies in the subgroup with abnormal results from the Florinef protocol indicated that none of these patients had evidence of APA, so they had nontumorous primary aldosteronism (NTPA). Thus, failure to suppress PA to less than 10 ng/dl with saline infusion is characteristic of patients with APA. However, the normal level should be lowered to 5 ng/dl when screening is done for NTPA. Additional studies such as Florinef suppression are necessary to gain confidence about the diagnosis of NTPA in those patients with PA suppression of between 5 and 10 ng/dl after saline infusion.

Original languageEnglish (US)
Pages (from-to)717-723
Number of pages7
Issue number5
StatePublished - 1984


  • Adrenal gland
  • Aldosterone
  • Low-renin hypertension
  • Zona glomerulosa hyperplasia

ASJC Scopus subject areas

  • Internal Medicine


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