Significance of Adrenocorticotropin Stimulation Test in the Diagnosis of an Aldosterone-Producing Adenoma

Takuhiro Sonoyama, Masakatsu Sone, Kazutoshi Miyashita, Naohisa Tamura, Kenichi Yamahara, Kwijun Park, Naofumi Oyamada, Daisuke Taura, Megumi Inuzuka, Katsutoshi Kojima, Kyoko Honda, Yasutomo Fukunaga, Naotetsu Kanamoto, Masako Miura, Akihiro Yasoda, Hiroshi Arai, Hiroshi Itoh, Kazuwa Nakao

Research output: Contribution to journalArticlepeer-review

32 Citations (Scopus)

Abstract

Context: Adrenal venous sampling is the "gold standard" test in the diagnosis of an aldosterone-producing adenoma (APA) among patients with primary aldosteronism (PA) but is available only in specialized medical centers. Meanwhile, an APA is reported to be generally more sensitive to ACTH than idiopathic hyperaldosteronism. Objective: The aim was to evaluate the diagnostic accuracy of the ACTH stimulation test in the diagnosis of an APA among those with suspicion of PA. Patients and Setting: Fifty-nine patients admitted to Kyoto University Hospital on suspicion of PA were included in the study. Interventions: ACTH stimulation tests with 1-mg dexamethasone suppression were performed. Main Outcome Measure: Plasma aldosterone concentrations (PAC) were examined every 30 min after ACTH stimulation. Receiver-operated characteristics curve analysis was used to evaluate the diagnostic accuracy. Results: PAC after ACTH stimulations were significantly higher in patients with an APA than in patients with idiopathic hyperaldosteronism or non-PA. Receiver-operated characteristics curve analyses showed that the PAC after ACTH stimulation was effective for the diagnosis of an APA among patients suspected of PA. The diagnostic accuracy was highest at 90 min after ACTH injection, with the optimal cutoff value greater than 37.9 ng/dl corresponding with sensitivity and specificity of 91.3 and 80.6% for the diagnosis of an APA. Conclusions: Our study indicates that the ACTH stimulation test is useful in the diagnosis of an APA among patients suspected of PA. This test can be used to select patients who are highly suspected of anAPAand definitely require adrenal venous sampling.

Original languageEnglish
Pages (from-to)2771-2778
Number of pages8
JournalJournal of Clinical Endocrinology and Metabolism
Volume96
Issue number9
DOIs
Publication statusPublished - 2011 Sep

ASJC Scopus subject areas

  • Endocrinology, Diabetes and Metabolism
  • Biochemistry
  • Endocrinology
  • Clinical Biochemistry
  • Biochemistry, medical

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