Autor(es):Mostrar menos -

Freitas, Thais C. ; Maciel, Ana Alice W. ; Fagundes, Gustavo F. C. ; Petenuci, Janaina ; Santana, Lucas S. ; Guimaraes, Augusto G. ; Freitas-Castro, Felipe ; Srougi, Victor ; Tanno, Fabio Y. ; Chambo, Jose L. ; Pereira, Maria Adelaide A. ; Brito, Luciana P. ; Pio-Abreu, Andrea ; Bortolotto, Luiz A. ; Latronico, Ana Claudia ; Fragoso, Maria Candida B., V ; Drager, Luciano F. ; Mendonca, Berenice B. ; Almeida, Madson Q.

• Tipo de documento: Artigo Científico
• Fonte: JOURNAL OF THE ENDOCRINE SOCIETY; v. 8, n. 1, p. 10-pg., 2023-12-01.

Resumo

Context: Confirmatory tests represent a fundamental step in primary aldosteronism (PA) diagnosis, but they are laborious and often require a hospital environment due to the risks involved.Objective: To evaluate the efficacy of oral furosemide as a new confirmatory test for PA diagnosis.Methods: We prospectively evaluated the diagnostic performance of 80 mg of oral furosemide in 64 patients with PA and 22 with primary hypertension (controls). Direct renin concentration (DRC) was measured before, and 2 hours and 3 hours after the oral furosemide. In addition, the oral furosemide test was compared with 2 other confirmatory tests: the furosemide upright test (FUT) and saline infusion test (SIT) or captopril challenge test (CCT) in all patients with PA.Results: The cut-off of 7.6 mu U/mL for DRC at 2 hours after oral furosemide had a sensitivity of 92%, specificity of 82%, and accuracy of 90% for PA diagnosis. In 5 out of 6 controls with low-renin hypertension, which might represent a PA spectrum, renin remained suppressed. Excluding these 6 controls with low-renin hypertension, the DRC cut-off of 10 mu U/mL at 2 hours after oral furosemide had a sensitivity of 95.3%, specificity of 93.7% and accuracy of 95% for PA diagnosis. DRC after 3 hours of oral furosemide did not improve diagnostic performance. Using the cut-off of 10 mu U/mL, the oral furosemide test and the FUT were concordant in 62 out of 64 (97%) patients with PA. Only 4 out of 64 cases with PA (6.4%) ended the oral furosemide test with potassium <3.5 mEq/L. Hypotension was not evidenced in any patient with PA during the test.Conclusion: The oral furosemide test was safe, well-tolerated and represents an effective strategy for PA investigation. (AU)

• Processo FAPESP: 21/10101-5 - Investigação de novas alterações genética associadas à patogênese dos Aldosteronomas por sequenciamento exômico
• Beneficiário: Augusto Garcia Guimarães
• Modalidade de apoio: Bolsas no Brasil - Doutorado Direto
• Processo FAPESP: 21/11240-9 - Sequenciamento completo do exoma para investigação de novas causas genéticas dos Feocromocitomas e Paragangliomas metastáticos
• Beneficiário: Felipe Freitas de Castro
• Modalidade de apoio: Bolsas no Brasil - Pós-Doutorado
• Processo FAPESP: 21/10363-0 - Sequenciamento completo do exoma para investigação de novas causas genéticas do Hiperaldosteronismo primário causado por hiperplasia adrenal bilateral
• Beneficiário: Lucas Santos de Santana
• Modalidade de apoio: Bolsas no Brasil - Pós-Doutorado
• Processo FAPESP: 19/15873-6 - Investigação de novos aspectos genéticos, clínicos e anatomopatológicos da hipertensão arterial de origem endócrina
• Beneficiário: Madson Queiroz Almeida
• Modalidade de apoio: Auxílio à Pesquisa - Temático
• Processo FAPESP: 21/09879-1 - Investigação clínica e genética da associação entre Hiperaldosteronismo Primário e Câncer Papilífero de Tireoide
• Beneficiário: Ana Alice Wolf Maciel
• Modalidade de apoio: Bolsas no Brasil - Doutorado Direto