{"doi":"10.1093/ejendo/lvae099","title":"Saline suppression testing-induced hypocalcemia and implications for clinical interpretations","abstract":"BACKGROUND: Extracellular calcium critically regulates physiologic aldosterone production. Moreover, abnormal calcium flux and signaling are involved in the pathogenesis of the majority of primary aldosteronism cases. METHODS: We investigated the influence of the saline suppression test (SST) on calcium homeostasis in prospectively recruited participants (n = 86). RESULTS: During SST, 100% of participants had decreases in serum calcium, with 48% developing frank hypocalcemia. Serum calcium declined from 2.30 ± 0.08 mmol/L to 2.13 ± 0.08 mmol/L (P < .001) with parallel increases in parathyroid hormone from 6.06 ± 2.39 pmol/L to 8.13 ± 2.42 pmol/L (P < .001). In contrast, serum potassium and bicarbonate did not change, whereas eGFR increased and serum glucose decreased (P < .001). Lower body surface area (translating to greater effective circulating volume expansion during SST) was associated with greater reductions in (β = .33, P = .001), and absolutely lower, serum calcium levels (β = .25, P = .001). When evaluating clinically-relevant diagnostic thresholds, participants with post-SST aldosterone levels <138 pmol/L had lower post-SST calcium and 25-hydroxyvitamin D levels (P < .05), and higher post-SST parathyroid hormone levels (P < .05) compared with those with post-SST aldosterone levels >277 pmol/L. CONCLUSION: SST uniformly decreases serum calcium, which is likely to be due to the combination of variable dilution, increased renal clearance, and vitamin D status. These acute reductions in bioavailable calcium are associated with lower post-SST aldosterone. Given the critical role of extracellular calcium in regulating aldosterone production, these findings warrant renewed inquiry into the validity of SST interpretations for excluding primary aldosteronism.","journal":"European Journal of Endocrinology","year":2024,"id":456260,"datarank":0.29188652235829704,"base_score":1.9459101490553132,"endowment":1.9459101490553132,"self_citation_contribution":0.29188652235829704,"citation_network_contribution":0.0,"self_endowment_contribution":0.29188652235829704,"citer_contribution":0.0,"corpus_percentile":null,"corpus_rank":null,"citation_count":6,"citer_count":0,"citers_with_citation_signal":0,"citers_with_endowment":0,"datacite_reuse_total":0,"is_dataset":false,"is_dataset_confidence":0.9602,"is_data_producer":false,"deposit_databanks":null,"is_oa":true,"file_count":0,"downloads":0,"has_version_chain":false,"published_date":"2024-01-01","fair_score":null,"fair_percentile":null,"algorithm_id":"datarank_citation_only_1hop_v6","ranking_scope":"data_only","authors":[{"id":301182,"name":"Jenifer M. Brown","orcid":"0000-0002-6647-639X","position":1,"is_corresponding":false},{"id":1206231,"name":"Julia Milks","orcid":null,"position":2,"is_corresponding":false},{"id":1205369,"name":"Laura C Tsai","orcid":"0009-0008-5344-2589","position":3,"is_corresponding":false},{"id":473428,"name":"Justin Chan","orcid":"0000-0002-0056-8224","position":4,"is_corresponding":false},{"id":1205370,"name":"Anna Moore","orcid":"0000-0001-9614-3812","position":5,"is_corresponding":false},{"id":1206230,"name":"Yvonne Niebuhr","orcid":null,"position":6,"is_corresponding":false},{"id":1205371,"name":"Brooke Honzel","orcid":"0009-0005-2824-903X","position":7,"is_corresponding":false},{"id":729665,"name":"Andrew J Newman","orcid":"0000-0002-8326-1964","position":8,"is_corresponding":false},{"id":263020,"name":"Anand Vaidya","orcid":"0000-0002-0314-9252","position":9,"is_corresponding":false},{"id":732777,"name":"Wasita Warachit Parksook","orcid":"0000-0001-7963-9621","position":0,"is_corresponding":true}],"reference_count":64,"raw_metadata":{"citation_network_status":"fetched"},"created_at":"2026-07-19T02:03:27.785212Z","pmid":"39073780","pmcid":null,"fwci":null,"citation_percentile":null,"influential_citations":0,"oa_status":null,"license":null,"views":0,"total_file_size_bytes":0,"version_count":0,"fair_f":null,"fair_a":null,"fair_i":null,"fair_r":null,"fair_zscore":null,"fair_rationale":null,"fair_model":null,"fair_agent_version":null,"fair_fulltext_source":null,"fair_has_llm":null,"fair_computed_at":null,"clinical_trials":[],"software_tools":[],"db_accessions":[],"linked_datasets":[],"topics":[]}