title: Significance of adrenocorticotropin stimulation test in the diagnosis of an aldosterone-producing adenoma.
abstract: BACKGROUND
  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.
  
  
  METHODS
  Fifty-nine patients admitted to Kyoto University Hospital on suspicion of PA were included in the study.
  
  
  METHODS
  ACTH stimulation tests with 1-mg dexamethasone suppression were performed.
  
  
  METHODS
  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 an APA and definitely require adrenal venous sampling.
authors.affiliation: Department of Medicine and Clinical Science, Kyoto University Graduate School of Medicine, 54 Shogoin Kawahara-cho, Sakyo-ku, Kyoto 606-8507, Japan. sonemasa@kuhp.kyoto-u.ac.jp.
authors.forename: Takuhiro
authors.initials: T
authors.lastname: Sonoyama
authors.forename: Masakatsu
authors.initials: M
authors.lastname: Sone
authors.forename: Kazutoshi
authors.initials: K
authors.lastname: Miyashita
authors.forename: Naohisa
authors.initials: N
authors.lastname: Tamura
authors.forename: Kenichi
authors.initials: K
authors.lastname: Yamahara
authors.forename: Kwijun
authors.initials: K
authors.lastname: Park
authors.forename: Naofumi
authors.initials: N
authors.lastname: Oyamada
authors.forename: Daisuke
authors.initials: D
authors.lastname: Taura
authors.forename: Megumi
authors.initials: M
authors.lastname: Inuzuka
authors.forename: Katsutoshi
authors.initials: K
authors.lastname: Kojima
authors.forename: Kyoko
authors.initials: K
authors.lastname: Honda
authors.forename: Yasutomo
authors.initials: Y
authors.lastname: Fukunaga
authors.forename: Naotetsu
authors.initials: N
authors.lastname: Kanamoto
authors.forename: Masako
authors.initials: M
authors.lastname: Miura
authors.forename: Akihiro
authors.initials: A
authors.lastname: Yasoda
authors.forename: Hiroshi
authors.initials: H
authors.lastname: Arai
authors.forename: Hiroshi
authors.initials: H
authors.lastname: Itoh
authors.forename: Kazuwa
authors.initials: K
authors.lastname: Nakao
mesh_terms: D000236:Adenoma / Q000097:blood / Q000175:diagnosis* / Q000378:metabolism; D000306:Adrenal Cortex Neoplasms / Q000097:blood / Q000175:diagnosis* / Q000378:metabolism; D000324:Adrenocorticotropic Hormone; D000450:Aldosterone / Q000097:blood / Q000378:metabolism*; D003907:Dexamethasone; D005260:Female; D006801:Humans; D006929:Hyperaldosteronism / Q000097:blood / Q000175:diagnosis*; D008297:Male; D008875:Middle Aged
chemical_list: D000450:Aldosterone; D003907:Dexamethasone; D000324:Adrenocorticotropic Hormone