title: PTH Is a Promising Auxiliary Index for the Clinical Diagnosis of Aldosterone-Producing Adenoma.
abstract: BACKGROUND
  Parathyroid hormone (PTH) stimulates aldosterone secretion in human adrenocortex and is regulated by the renin-angiotensin-aldosterone system. We speculated that measurement of PTH may be a valuable aid in the diagnosis of aldosterone-producing adenoma (APA).
  
  
  METHODS
  To test this hypothesis, we recruited 142 patients with adrenal adenoma, of whom 84 had an APA and 58 had a nonfunctioning adrenal adenoma (NFA). Plasma levels of intact PTH, serum potassium, sodium, calcium, phosphate, 25(OH) vitamin D, plasma aldosterone concentration (PAC), plasma renin activity (PRA), and aldosterone to renin ratio (ARR) were measured in every patient. Computed tomography (CT) scanning of the adrenal gland and adrenal hormone levels was used to evaluate the function of the adrenal adenoma. We also evaluated the impact of renin-angiotensin-aldosterone system (RAAS) components on PTH from the recumbent-upright test in 15 patients with APA and 30 patients with NFA.
  
  
  RESULTS
  Compared with NFA, PTH levels were significantly increased in patients with APA, and serum calcium and phosphate were significantly decreased. When position was changed from supine to upright, the variation in PTH levels was significantly higher in APA patients compared with NFA patients. Receiver operator characteristic (ROC) curves identified the Youden index, which corresponded to the best tradeoff of combined marker (ARR and PTH) with a sensitivity and specificity of 89.3% and 93.1%, respectively.
  
  
  CONCLUSIONS
  The baseline and positional variation of serum PTH levels were significant in APA, thus PTH may be a promising auxiliary index for the clinical diagnosis of APA.
authors: Medical Center, Tsinghua University, Beijing, China; Department of Endocrinology, Chinese PLA General Hospital, Beijing, China;
authors: Lin-Xi
authors: LX
authors: Zhang
authors: Department of Endocrinology, Chinese PLA General Hospital, Beijing, China;
authors: Wei-Jun
authors: WJ
authors: Gu
authors: Department of Endocrinology, Chinese PLA General Hospital, Beijing, China;
authors: Yi-Jun
authors: YJ
authors: Li
authors: Medical Research & Biometrics Center, Cardiovascular Institute and Fuwai Hospital, National Center for Cardiovascular Diseases China, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China.
authors: Yang
authors: Y
authors: Wang
authors: Department of Endocrinology, Chinese PLA General Hospital, Beijing, China;
authors: Wen-Bo
authors: WB
authors: Wang
authors: Department of Endocrinology, Chinese PLA General Hospital, Beijing, China;
authors: An-Ping
authors: AP
authors: Wang
authors: Department of Endocrinology, Chinese PLA General Hospital, Beijing, China;
authors: Lei
authors: L
authors: Shen
authors: Department of Endocrinology, Chinese PLA General Hospital, Beijing, China;
authors: Li
authors: L
authors: Zang
authors: Department of Endocrinology, Chinese PLA General Hospital, Beijing, China;
authors: Guo-Qing
authors: GQ
authors: Yang
authors: Department of Endocrinology, Chinese PLA General Hospital, Beijing, China;
authors: Zhao-Hui
authors: ZH
authors: Lu
authors: Department of Endocrinology, Chinese PLA General Hospital, Beijing, China;
authors: Jing-Tao
authors: JT
authors: Dou
authors: Department of Endocrinology, Chinese PLA General Hospital, Beijing, China; muyiming@301hospital.com.cn.
authors: Yi-Ming
authors: YM
authors: Mu
mesh_terms: D000236:Adenoma / Q000097:blood / Q000175:diagnosis* / Q000378:metabolism; D000310:Adrenal Gland Neoplasms / Q000097:blood / Q000175:diagnosis* / Q000378:metabolism / Q000652:urine; D000328:Adult; D000450:Aldosterone / Q000097:blood / Q000378:metabolism* / Q000652:urine; D019540:Area Under Curve; D014408:Biomarkers, Tumor / Q000097:blood* / Q000378:metabolism* / Q000652:urine; D055664:Electrochemical Techniques; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D010281:Parathyroid Hormone / Q000097:blood*; D056888:Patient Positioning; D011237:Predictive Value of Tests; D012372:ROC Curve; D015203:Reproducibility of Results; D016683:Supine Position; D014057:Tomography, X-Ray Computed; D015854:Up-Regulation
chemical_list: D014408:Biomarkers, Tumor; C470125:PTH protein, human; D010281:Parathyroid Hormone; D000450:Aldosterone
keywords: aldosterone; aldosterone-producing adenoma; blood pressure; hypertension; nonfunctioning adenoma; parathyroid hormone.