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

Moriya, Ayako; Yamamoto, Masaaki; Kobayashi, Shunsuke; Nagamine, Tomoko; Takeichi-Hattori, Naomi; Nagao, Mototsugu LU ; Harada, Taro; Tanimura-Inagaki, Kyoko; Onozawa, Shiro and Murata, Satoru, et al. (2017) In Endocrine Journal 64(1). p.65-73
Abstract

The diagnostic steps for primary aldosteronism (PA) include case screening tests, confirmatory tests, and localization. The aim of this study was to identify useful confirmatory tests and their cut-off values for differentiating the subtype of primary aldosteronism, especially in unilateral PA, such as aldosterone-producing adenoma, and bilateral PA, such as idiopathic hyperaldosteronism. Seventy-six patients who underwent all four confirmatory tests, the captopril-challenge test (CCT), furosemide upright test (FUT), saline infusion test (SIT), and ACTH stimulation test (AST), and who were confirmed to have an aldosterone excess by adrenal venous sampling (AVS) were recruited. Subjects were diagnosed as having unilateral aldosterone... (More)

The diagnostic steps for primary aldosteronism (PA) include case screening tests, confirmatory tests, and localization. The aim of this study was to identify useful confirmatory tests and their cut-off values for differentiating the subtype of primary aldosteronism, especially in unilateral PA, such as aldosterone-producing adenoma, and bilateral PA, such as idiopathic hyperaldosteronism. Seventy-six patients who underwent all four confirmatory tests, the captopril-challenge test (CCT), furosemide upright test (FUT), saline infusion test (SIT), and ACTH stimulation test (AST), and who were confirmed to have an aldosterone excess by adrenal venous sampling (AVS) were recruited. Subjects were diagnosed as having unilateral aldosterone excess (n=17) or bilateral aldosterone excess (n=59) by AVS. The SIT-positive rate was significantly higher in the unilateral group (94.1%) than in the bilateral group (57.6%). Multivariable logistic regression analysis showed that tumor on computed tomography (CT) and plasma aldosterone concentration (PAC)max/cortisol on the AST were useful for differentiating the subtype of PA. Receiver operating characteristic (ROC) curve analysis for distinguishing the subtype of PA showed that a cut-off value of 18.3 PACmax/cortisol on the AST had a sensitivity of 83% and a specificity of 88%. The area under the ROC curve was 0.918 (95% confidence interval 0.7916–0.9708). These data suggest that abdominal CT and AST are useful for differentiating the subtype of PA and the indication for AVS.

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type
Contribution to journal
publication status
published
keywords
ACTH stimulation test, Computed tomography, Primary aldosteronism, Saline infusion test, Subtype
in
Endocrine Journal
volume
64
issue
1
pages
9 pages
publisher
Japan Endocrine Society
external identifiers
  • scopus:85010991058
ISSN
0918-8959
DOI
10.1507/endocrj.EJ16-0297
language
English
LU publication?
no
id
0daa284a-e1b1-4c60-803b-6c5ca5fc2347
date added to LUP
2017-08-23 19:58:00
date last changed
2017-08-27 06:46:33
@article{0daa284a-e1b1-4c60-803b-6c5ca5fc2347,
  abstract     = {<p>The diagnostic steps for primary aldosteronism (PA) include case screening tests, confirmatory tests, and localization. The aim of this study was to identify useful confirmatory tests and their cut-off values for differentiating the subtype of primary aldosteronism, especially in unilateral PA, such as aldosterone-producing adenoma, and bilateral PA, such as idiopathic hyperaldosteronism. Seventy-six patients who underwent all four confirmatory tests, the captopril-challenge test (CCT), furosemide upright test (FUT), saline infusion test (SIT), and ACTH stimulation test (AST), and who were confirmed to have an aldosterone excess by adrenal venous sampling (AVS) were recruited. Subjects were diagnosed as having unilateral aldosterone excess (n=17) or bilateral aldosterone excess (n=59) by AVS. The SIT-positive rate was significantly higher in the unilateral group (94.1%) than in the bilateral group (57.6%). Multivariable logistic regression analysis showed that tumor on computed tomography (CT) and plasma aldosterone concentration (PAC)<sub>max</sub>/cortisol on the AST were useful for differentiating the subtype of PA. Receiver operating characteristic (ROC) curve analysis for distinguishing the subtype of PA showed that a cut-off value of 18.3 PAC<sub>max</sub>/cortisol on the AST had a sensitivity of 83% and a specificity of 88%. The area under the ROC curve was 0.918 (95% confidence interval 0.7916–0.9708). These data suggest that abdominal CT and AST are useful for differentiating the subtype of PA and the indication for AVS.</p>},
  author       = {Moriya, Ayako and Yamamoto, Masaaki and Kobayashi, Shunsuke and Nagamine, Tomoko and Takeichi-Hattori, Naomi and Nagao, Mototsugu and Harada, Taro and Tanimura-Inagaki, Kyoko and Onozawa, Shiro and Murata, Satoru and Tamura, Hideki and Fukuda, Izumi and Oikawa, Shinichi and Sugihara, Hitoshi},
  issn         = {0918-8959},
  keyword      = {ACTH stimulation test,Computed tomography,Primary aldosteronism,Saline infusion test,Subtype},
  language     = {eng},
  number       = {1},
  pages        = {65--73},
  publisher    = {Japan Endocrine Society},
  series       = {Endocrine Journal},
  title        = {ACTH stimulation test and computed tomography are useful for differentiating the subtype of primary aldosteronism},
  url          = {http://dx.doi.org/10.1507/endocrj.EJ16-0297},
  volume       = {64},
  year         = {2017},
}