ACTH stimulation test and computed tomography are useful for differentiating the subtype of primary aldosteronism

Moriya, Atsushi; Yamamoto, Masaaki; Kobayashi, Shunsuke; Nagamine, Tomoko; Takeichi-Hattori, Naomi; Nagao, Mototsugu; Harada, Taro; Tanimura-Inagaki, Kyoko; Onozawa, Shiro; Murata, Satoru; Tamura, Hideki; Izumi, Fujio; Oikawa, Shinichi; Sugihara, Hitoshi

doi:10.1507/endocrj.ej16-0297

Cited by 10 publications

(19 citation statements)

References 26 publications

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“…A previous study showed that aldosterone secretion was hypersensitive to even very low dose ACTH (0.003 IU) that was not sufficient to stimulate cortisol secretion [12]. In this context, it has been considered that AST might be a useful tool for PA diagnosis, and several studies have been conducted to clarify the diagnostic accuracy of AST for detecting PA and/or PA subtypes, particularly in Asia [8,9,10]. The majority of these studies performed AST under 1-mg DS in order to eliminate endogenous ACTH-mediated aldosterone hypersecretion [8,9].…”

Section: Discussionmentioning

confidence: 99%

“…ACTH stimulation test (AST) was first established in 1978 [7], when it was shown that PAC responsiveness to ACTH stimulation in PA patients was significantly higher than in essential hypertensive subjects. More recently, studies have assessed the diagnostic accuracy of AST for PA and/or PA subtypes [8,9,10]. However, some studies performed AST during 1-mg dexamethasone suppression (DS) in order to eliminate the action of endogenous ACTH [8,9] while others did not [10].…”

Section: Introductionmentioning

confidence: 99%

“…More recently, studies have assessed the diagnostic accuracy of AST for PA and/or PA subtypes [8,9,10]. However, some studies performed AST during 1-mg dexamethasone suppression (DS) in order to eliminate the action of endogenous ACTH [8,9] while others did not [10]. The effect of 1-mg DS on AST is unclear and assessing this effect is important to perform and precisely evaluate the results of AST.…”

Section: Introductionmentioning

confidence: 99%

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Clinical Utility of the Adrenocorticotropin Stimulation Test with/without Dexamethasone Suppression for Definitive and Subtype Diagnosis of Primary Aldosteronism

Inoue

Omura

Sugisawa

et al. 2017

IJMS

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The adrenocorticotropin (ACTH) stimulation test (AST) has been reported to be useful for diagnosing primary aldosteronism (PA), particularly for differentiating PA subtypes under 1-mg dexamethasone suppression (DS). The aim of our study was to clarify the effect of 1-mg DS on AST results. A retrospective cohort study was conducted using data for 48 patients (PA: 30/48). We estimated the difference in plasma aldosterone concentration (PAC) responsiveness to ACTH stimulation with single (AST alone) and combined (AST under 1-mg DS) tests within the same patient. We compared the diagnostic accuracy of these two tests for PA and the laterality of hyperaldosteronism. We found no differences in PAC responsiveness to ACTH stimulation between single and combined tests, and observed a significant positive linear relationship (30 min, R2 = 0.75, p-value < 0.01). Both tests showed the highest diagnostic accuracy for PA following 30 min of ACTH stimulation. The ability to detect the laterality of hyperaldosteronism was inconsistent and differed according to the two definitions: lateralization ratio and the absolute aldosterone levels in adrenal venous sampling. PAC responsiveness to ACTH stimulation was similar for AST with and without 1-mg DS. AST can be performed under both conditions with similar accuracy to detect PA.

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Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

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Clinical Utility of the Adrenocorticotropin Stimulation Test with/without Dexamethasone Suppression for Definitive and Subtype Diagnosis of Primary Aldosteronism

Inoue

Omura

Sugisawa

et al. 2017

IJMS

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“…However, each model has its own specific predictors, such as estimated glomerular filtration rate (eGFR), urinary aldosterone level, plasma aldosterone concentration (PAC) to plasma rennin activity (PRA) ratio (ARR) after captopril challenge test (CCT) and post‐SIT PAC. In addition, clinical variables and tests have been identified in differentiation between APA and IHA, such as age, parathyroid hormone, ACTH stimulation test, posture stimulation test and urinary 18‐hydroxycortisol …”

Section: Introductionmentioning

confidence: 99%

“…In addition, clinical variables and tests have been identified in differentiation between APA and IHA, such as age, parathyroid hormone, ACTH stimulation test, posture stimulation test and urinary 18-hydroxycortisol. [6][7][8][9][11][12][13][14][15][16][17] Computed tomography findings are inadequate for subtype diagnosis because of the presence of microadenoma, nonfunctioning adenoma or the coexistence of both. [18][19][20][21][22] That is, even if CT findings or clinical scales could specifically distinguish IHA from APA, we could not decide which adrenal gland is presenting excessive secretion.…”

Section: Introductionmentioning

confidence: 99%

A novel clinical nomogram to predict bilateral hyperaldosteronism in Chinese patients with primary aldosteronism

Wang¹,

Jiang²,

Zhang³

et al. 2019

Clinical Endocrinology

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Summary Context Adrenal venous sampling (AVS) is recommended as the gold standard for subtype classification in primary aldosteronism (PA); however, this approach has limited availability. Objective We aimed to develop a novel clinical nomogram to predict PA subtype based on routine variables, thereby reducing the number of candidates for AVS. Patients and method Patients were randomly divided into a training set (n = 185) and a validation set (n = 79). Risk factors for idiopathic hyperaldosteronism (IHA) differentiating from aldosterone‐producing adenoma (APA) were identified using logistic regression analysis. A nomogram was constructed to predict the probability of IHA. A receiver operating characteristic (ROC) curve and a calibration plot were applied to assess the predictive value. Then, 115 patients were prospectively enrolled, and a nomogram was used to predict the subtypes before AVS. Results Body mass index (BMI), serum potassium and computed tomography (CT) finding were adopted in the nomogram. The nomogram presented an area under the ROC (AUC) of 0.924 (95% CI: 0.875‐0.957), sensitivity of 86.59% and specificity of 87.38% in the training set and an AUC of 0.894 (95% CI: 0.804‐0.952), sensitivity of 82.86% and specificity of 84.09% in the validation set. Predicted probability and actual probability matched well in the nomogram (Hosmer‐Lemeshow test: P > 0.05). Using the nomogram as a surrogate to predict IHA in the prospective set before AVS, the specificity reached 100% when we increased the threshold to a probability of 90%. Conclusion We have developed a tool that is able to predict IHA in patients with PA and potentially avoid AVS.

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Association of achieved blood pressure after treatment for primary aldosteronism with long-term kidney function

et al. 2021

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ACTH stimulation test and computed tomography are useful for differentiating the subtype of primary aldosteronism

Cited by 10 publications

References 26 publications

Clinical Utility of the Adrenocorticotropin Stimulation Test with/without Dexamethasone Suppression for Definitive and Subtype Diagnosis of Primary Aldosteronism

Clinical Utility of the Adrenocorticotropin Stimulation Test with/without Dexamethasone Suppression for Definitive and Subtype Diagnosis of Primary Aldosteronism

A novel clinical nomogram to predict bilateral hyperaldosteronism in Chinese patients with primary aldosteronism

Association of achieved blood pressure after treatment for primary aldosteronism with long-term kidney function

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