Evaluation of the (1-24) adrenocorticotropin stimulation test for the diagnosis
of primary aldosteronism
#MMPMID27009282
Terui K
; Kageyama K
; Nigawara T
; Moriyama T
; Sakihara S
; Takayasu S
; Tsushima Y
; Watanki Y
; Yamagata S
; Sugiyama A
; Murasawa S
; Nakada Y
; Suda T
; Daimon M
J Renin Angiotensin Aldosterone Syst
2016[Jan]; 17
(1
): 1470320315625703
PMID27009282
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OBJECTIVE: The purpose of this study was to investigate the diagnostic power of
the adrenocorticotropin (ACTH) stimulation test in patients with primary
aldosteronism (PA) and those with aldosterone-producing adenoma (APA). DESIGN:
This study was based on a retrospective database analysis. SUBJECTS AND METHODS:
We assessed 158 hypertensive patients with a high plasma aldosterone-to-renin
ratio (ARR) including 97 with at least one positive confirmatory test result who
did not undergo surgery and comprised a "possible PA" group, 19 with negative
results in all tests who were the "non-PA" group, and 41 diagnosed with APA
following surgery who were the APA group. The "confirmed PA group" included APA
patients and patients from the possible PA group showing both high ARR and
hypokalemia. One case was diagnosed as a metastasis. RESULTS: Receiver-operating
characteristic (ROC) analysis showed that the diagnostic accuracy of ACTH test
was not very effective in differentiating between APA patients and possible PA
and non-PA patients. The optimal cut-off value of maximal plasma aldosterone
concentration for differentiating between patient in the confirmed PA group and
other patients showed moderate accuracy. CONCLUSIONS: The ACTH test may not be
useful as a screening or confirmatory test, but the test may be useful for
differentiating between patients with confirmed PA and the rest of the cohort.
The positive finding of the ACTH test may at least support a higher likelihood of
lateralizing on adrenal venous sampling.
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