Patient population and diagnostic methods

This study was a retrospective cohort study. We reviewed the records of 48 patients who were diagnosed with PA based on the results of the ARR over 20 and plasma aldosterone concentration (PAC) over 15 ng/dL [9] and those who underwent AVS between January 2009 and June 2017 at a tertiary referral hospital. Saline infusion test (SIT) is performed as a confirmatory test after withdrawal of antihypertensive agents which may influence plasma renin concentration for at least 2-to-4 weeks. The SIT started at 8: 00 A.M. Before the test, patients kept in the recumbent position for at least 2 h. After sampling for baseline PAC and renin with measurement of blood pressure (BP) with heart rate, 2 l of saline were infused over 4 h. PAC, renin, and BP with heart rate were measured after saline loading. PAC of 10 ng/dL in recumbent position or 6 ng/dL in seated position is considered as confirmative cut-off value [10]. All patients underwent adrenal CT scan imaging to check the morphological changes of both adrenal glands. All study participants received either medical or surgical treatments based on their integrated clinical information and AVS results. All patients were allowed for a 4- to-8 week visit to endocrinology clinics and were followed up at least 1 year after decisive AVS results.