title: Role of endogenous ACTH on circadian aldosterone rhythm in patients with primary aldosteronism.
abstract: We recently reported that stimulation with high-dose ACTH caused different responses in terms of aldosterone secretion in aldosterone-producing adenomas (APAs) and idiopathic hyperaldosteronism (IHA) in patients with primary aldosteronism (PA). However, the role of endogenous ACTH in aldosterone secretion in PA has not been systematically evaluated. In this study, we examined diurnal changes in plasma aldosterone concentration (PAC), and changes in PAC after dexamethasone administration in patients with suspected PA, in order to evaluate the effect of endogenous ACTH on aldosterone secretion. Seventy-three patients admitted to Kyoto University Hospital with suspected PA were included. The patients were classified into non-PA, IHA, and APA groups according to the results of captopril challenge test and adrenal venous sampling. PAC at 0900 h (PAC0900), 2300 h (PAC2300), and after 1-mg dexamethasone suppression test (PACdex) was measured and compared among the three groups. The PAC2300/PAC0900 and PACdex/PAC0900 ratios were also analyzed. PAC2300 and PACdex were lower than PAC0900 in all three groups. There were no significant differences in PAC2300/PAC0900 among the three groups. However, PACdex/PAC0900 was significantly lower in the APA group compared with the non-PA and IHA groups. The results of this study indicate that aldosterone secretion in APA patients is more strongly dependent on endogenous ACTH than in IHA and non-PA patients. The results also suggest that factors other than ACTH, such as clock genes, may cause diurnal changes in aldosterone secretion in IHA and non-PA patients.
authors.affiliation: Department of Medicine and Clinical ScienceKyoto University Graduate School of Medicine, 54 Shogoin Kawahara-cho, Sakyo-ku, Kyoto 606-8507, Japan.
authors.forename: Takuhiro
authors.initials: T
authors.lastname: Sonoyama
authors.affiliation: Department of Medicine and Clinical ScienceKyoto University Graduate School of Medicine, 54 Shogoin Kawahara-cho, Sakyo-ku, Kyoto 606-8507, Japan sonemasa@kuhp.kyoto-u.ac.jp.
authors.forename: Masakatsu
authors.initials: M
authors.lastname: Sone
authors.affiliation: Department of Medicine and Clinical ScienceKyoto University Graduate School of Medicine, 54 Shogoin Kawahara-cho, Sakyo-ku, Kyoto 606-8507, Japan.
authors.forename: Naohisa
authors.initials: N
authors.lastname: Tamura
authors.affiliation: Department of Medicine and Clinical ScienceKyoto University Graduate School of Medicine, 54 Shogoin Kawahara-cho, Sakyo-ku, Kyoto 606-8507, Japan.
authors.forename: Kyoko
authors.initials: K
authors.lastname: Honda
authors.affiliation: Department of Medicine and Clinical ScienceKyoto University Graduate School of Medicine, 54 Shogoin Kawahara-cho, Sakyo-ku, Kyoto 606-8507, Japan.
authors.forename: Daisuke
authors.initials: D
authors.lastname: Taura
authors.affiliation: Department of Medicine and Clinical ScienceKyoto University Graduate School of Medicine, 54 Shogoin Kawahara-cho, Sakyo-ku, Kyoto 606-8507, Japan.
authors.forename: Katsutoshi
authors.initials: K
authors.lastname: Kojima
authors.affiliation: Department of Medicine and Clinical ScienceKyoto University Graduate School of Medicine, 54 Shogoin Kawahara-cho, Sakyo-ku, Kyoto 606-8507, Japan.
authors.forename: Yorihide
authors.initials: Y
authors.lastname: Fukuda
authors.affiliation: Department of Medicine and Clinical ScienceKyoto University Graduate School of Medicine, 54 Shogoin Kawahara-cho, Sakyo-ku, Kyoto 606-8507, Japan.
authors.forename: Naotetsu
authors.initials: N
authors.lastname: Kanamoto
authors.affiliation: Department of Medicine and Clinical ScienceKyoto University Graduate School of Medicine, 54 Shogoin Kawahara-cho, Sakyo-ku, Kyoto 606-8507, Japan.
authors.forename: Masako
authors.initials: M
authors.lastname: Miura
authors.affiliation: Department of Medicine and Clinical ScienceKyoto University Graduate School of Medicine, 54 Shogoin Kawahara-cho, Sakyo-ku, Kyoto 606-8507, Japan.
authors.forename: Akihiro
authors.initials: A
authors.lastname: Yasoda
authors.affiliation: Department of Medicine and Clinical ScienceKyoto University Graduate School of Medicine, 54 Shogoin Kawahara-cho, Sakyo-ku, Kyoto 606-8507, Japan.
authors.forename: Hiroshi
authors.initials: H
authors.lastname: Arai
authors.affiliation: Department of Medicine and Clinical ScienceKyoto University Graduate School of Medicine, 54 Shogoin Kawahara-cho, Sakyo-ku, Kyoto 606-8507, Japan.
authors.forename: Hiroshi
authors.initials: H
authors.lastname: Itoh
authors.affiliation: Department of Medicine and Clinical ScienceKyoto University Graduate School of Medicine, 54 Shogoin Kawahara-cho, Sakyo-ku, Kyoto 606-8507, Japan.
authors.forename: Kazuwa
authors.initials: K
authors.lastname: Nakao
keywords: adrenal gland; adrenocorticotropic hormone; clinical medicine; hypertension; primary hyperaldosteronism