Burrello et al reported a score that can predict primary aldosteronism without confirmatory testing. The authors are from the University of Torino, University of Bologna and Ludwig-Maximilians-Universitat Munchen.
PACT = Primary Aldosteronism Confirmatory Testing
Patient selection: suspected primary aldosteronism
Problems with confirmatory testing:
(1) time-consuming
(2) expensive
(3) no consensus on testing
Parameters:
(1) sex
(2) number of antihypertensive medications taken
(3) plasma renin activity (PRA) at screening in ng/mL per h
(4) serum aldosterone at screening in ng/dL
(5) lowest serum potassium in mmol/L
(6) organ damage
Parameter
Finding
Points
sex
female
0
male
2
antihypertensive drugs
0
0
>= 1
1
PRA
< 0.2
3
0.20 to 0.99
1
>= 1.0
0
serum aldosterone
< 16.0
0
16.0 to 27.9
2
>= 28.0
4
lowest potassium
< 3.7
4
3.7 to 3.9
2
>= 4.0
0
organ damage
absent
0
present
2
total score =
= SUM(points for all of the parameters)
Interpretation:
• minimum score: 0
• maximum score: 16
PACT Score
Interpretation
Next Step
< 5
primary aldosteronism not confirmed
follow-up
5 to 12
perform confirmatory test
if confirmatory test positive then adrenal venous sample, else follow
13 to 16
primary aldosteronism confirmed
adrenal venous sampling
Performance:
• The area under the ROC curve is 0.88.
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