title: Diagnostic value of ACTH stimulation test in determining the subtypes of primary aldosteronism.
abstract: BACKGROUND
  Adrenal venous sampling is recommended as the golden standard for subtyping primary aldosteronism (PA). However, it is invasive and inconvenient, and seeking a better way to make differential diagnosis of PA is necessary.
  
  
  OBJECTIVE
  The objective of the study was to evaluate the diagnostic value of ACTH stimulation test under 1 mg dexamethasone suppression test (DST) in determining the subtypes of PA.
  
  
  METHODS
  Ninety-five patients with PA confirmed by saline infusion test were included in this study. According to adrenal venous sampling and histopathology, 39 patients were diagnosed as bilateral adrenal hyperplasia (BAH), 37 as aldosterone-producing adenoma (APA), and 19 as unilateral adrenal hyperplasia (UAH). An ACTH stimulation test under 1 mg DST was performed in all patients. Plasma aldosterone and cortisol levels were measured every 30 minutes until 120 minutes after the iv injection of 50 IU ACTH.
  
  
  RESULTS
  During the ACTH stimulation test, aldosterone levels in APA and UAH were similar (P > .05) but higher than those in BAH (P < .001). Furthermore, stimulated aldosterone levels of unilateral PA (APA and UAH) were significantly higher than bilateral PA (BAH) (P < .001). Receiver-operated characteristics curve analyses showed the aldosterone after ACTH stimulation was effective for distinguishing between unilateral PA and bilateral PA. The diagnostic accuracy was highest at 120 minutes after ACTH stimulation, and the optimal cutoff value of the aldosterone was 77.90 ng/dL, with a sensitivity of 76.8%, a specificity of 87.2%, a positive predictive value of 89.6%, and a negative predictive value of 72.3%.
  
  
  CONCLUSIONS
  The ACTH stimulation test under 1 mg DST is useful to determine the subtypes of PA, especially in unilateral and bilateral PA, and may guide further treatment in PA patients.
authors.affiliation: Shanghai Key Laboratory for Endocrine Tumors (Y.J., C.Z., W.W., T.S., W.Zhou., L.J., W.Zhu., G.N.), Shanghai Clinical Center for Endocrine and Metabolic Diseases, Shanghai Institute of Endocrine and Metabolic Diseases and Shanghai E-Institute for Endocrinology, Ruijin Hospital, Shanghai Jiaotong University, School of Medicine, Shanghai Key Laboratory for Endocrine Tumors (Y.J., C.Z., W.W., T.S., W.Zhou., L.J., W.Zhu., G.N.), Shanghai Clinical Center for Endocrine and Metabolic Diseases, Key Laboratory for Endocrine and Metabolic Diseases of Chinese Health Ministry, Ruijin Hospital Affiliated to Shanghai JiaoTong University School of Medicine, Laboratory for Endocrine and Metabolic Diseases of Institute of Health Science (W.W., G.N.), Shanghai JiaoTong University School of Medicine and Shanghai Institutes for Biological Sciences, Chinese Academy of Sciences, and Department of Pathology (J.X.), Ruijin Hospital affiliated to Shanghai Jiaotong University School of Medicine, Shanghai 200025, People's Republic of China.
authors.forename: Yiran
authors.initials: Y
authors.lastname: Jiang
authors.forename: Cui
authors.initials: C
authors.lastname: Zhang
authors.forename: Weiqing
authors.initials: W
authors.lastname: Wang
authors.forename: Tingwei
authors.initials: T
authors.lastname: Su
authors.forename: Weiwei
authors.initials: W
authors.lastname: Zhou
authors.forename: Lei
authors.initials: L
authors.lastname: Jiang
authors.forename: Wei
authors.initials: W
authors.lastname: Zhu
authors.forename: Jing
authors.initials: J
authors.lastname: Xie
authors.forename: Guang
authors.initials: G
authors.lastname: Ning
mesh_terms: D000236:Adenoma / Q000097:blood / Q000175:diagnosis* / Q000473:pathology; D000306:Adrenal Cortex Neoplasms / Q000097:blood / Q000175:diagnosis* / Q000473:pathology; D000311:Adrenal Glands / Q000473:pathology; D000312:Adrenal Hyperplasia, Congenital / Q000097:blood / Q000175:diagnosis* / Q000473:pathology; D000324:Adrenocorticotropic Hormone; D000328:Adult; D000450:Aldosterone / Q000097:blood; D003937:Diagnosis, Differential; D005260:Female; D006801:Humans; D006929:Hyperaldosteronism / Q000097:blood / Q000175:diagnosis* / Q000473:pathology; D008297:Male; D008875:Middle Aged; D010912:Pituitary-Adrenal Function Tests; D012680:Sensitivity and Specificity
chemical_list: D000450:Aldosterone; D000324:Adrenocorticotropic Hormone