title: Evaluation of the (1-24) adrenocorticotropin stimulation test for the diagnosis of primary aldosteronism.
abstract: OBJECTIVE
  The purpose of this study was to investigate the diagnostic power of the adrenocorticotropin (ACTH) stimulation test in patients with primary aldosteronism (PA) and those with aldosterone-producing adenoma (APA).
  
  
  METHODS
  This study was based on a retrospective database analysis.
  
  
  METHODS
  We assessed 158 hypertensive patients with a high plasma aldosterone-to-renin ratio (ARR) including 97 with at least one positive confirmatory test result who did not undergo surgery and comprised a "possible PA" group, 19 with negative results in all tests who were the "non-PA" group, and 41 diagnosed with APA following surgery who were the APA group. The "confirmed PA group" included APA patients and patients from the possible PA group showing both high ARR and hypokalemia. One case was diagnosed as a metastasis.
  
  
  RESULTS
  Receiver-operating characteristic (ROC) analysis showed that the diagnostic accuracy of ACTH test was not very effective in differentiating between APA patients and possible PA and non-PA patients. The optimal cut-off value of maximal plasma aldosterone concentration for differentiating between patient in the confirmed PA group and other patients showed moderate accuracy.
  
  
  CONCLUSIONS
  The ACTH test may not be useful as a screening or confirmatory test, but the test may be useful for differentiating between patients with confirmed PA and the rest of the cohort. The positive finding of the ACTH test may at least support a higher likelihood of lateralizing on adrenal venous sampling.
authors.affiliation: Department of Endocrinology and Metabolism, Hirosaki University Graduate School of Medicine, Japan Department of Endocrinology and Metabolism, Hirosaki University Graduate School of Medicine, Japan terui@hirosaki-u.ac.jp.
authors.forename: Ken
authors.initials: K
authors.lastname: Terui
authors.affiliation: Department of Endocrinology and Metabolism, Hirosaki University Graduate School of Medicine, Japan Department of Endocrinology and Metabolism, Hirosaki University Graduate School of Medicine, Japan.
authors.forename: Kazunori
authors.initials: K
authors.lastname: Kageyama
authors.affiliation: Department of Endocrinology and Metabolism, Hirosaki University Graduate School of Medicine, Japan Department of Endocrinology and Metabolism, Hirosaki University Graduate School of Medicine, Japan.
authors.forename: Takeshi
authors.initials: T
authors.lastname: Nigawara
authors.affiliation: Department of Endocrinology and Metabolism, Hirosaki University Graduate School of Medicine, Japan Department of Endocrinology and Metabolism, Hirosaki University Graduate School of Medicine, Japan.
authors.forename: Takako
authors.initials: T
authors.lastname: Moriyama
authors.affiliation: Aomori Rosai Hospital, Japan.
authors.forename: Satoru
authors.initials: S
authors.lastname: Sakihara
authors.affiliation: Department of Endocrinology and Metabolism, Hirosaki University Graduate School of Medicine, Japan Department of Endocrinology and Metabolism, Hirosaki University Graduate School of Medicine, Japan.
authors.forename: Shinobu
authors.initials: S
authors.lastname: Takayasu
authors.affiliation: Department of Endocrinology and Metabolism, Hirosaki University Graduate School of Medicine, Japan Department of Endocrinology and Metabolism, Hirosaki University Graduate School of Medicine, Japan.
authors.forename: Yuko
authors.initials: Y
authors.lastname: Tsushima
authors.affiliation: Department of Endocrinology and Metabolism, Hirosaki University Graduate School of Medicine, Japan Department of Endocrinology and Metabolism, Hirosaki University Graduate School of Medicine, Japan.
authors.forename: Yutaka
authors.initials: Y
authors.lastname: Watanki
authors.affiliation: Department of Endocrinology and Metabolism, Hirosaki University Graduate School of Medicine, Japan Department of Endocrinology and Metabolism, Hirosaki University Graduate School of Medicine, Japan.
authors.forename: Satoshi
authors.initials: S
authors.lastname: Yamagata
authors.affiliation: Department of Endocrinology and Metabolism, Hirosaki University Graduate School of Medicine, Japan Department of Endocrinology and Metabolism, Hirosaki University Graduate School of Medicine, Japan.
authors.forename: Aya
authors.initials: A
authors.lastname: Sugiyama
authors.affiliation: Department of Endocrinology and Metabolism, Hirosaki University Graduate School of Medicine, Japan Department of Endocrinology and Metabolism, Hirosaki University Graduate School of Medicine, Japan.
authors.forename: Shingo
authors.initials: S
authors.lastname: Murasawa
authors.affiliation: Department of Endocrinology and Metabolism, Hirosaki University Graduate School of Medicine, Japan Department of Endocrinology and Metabolism, Hirosaki University Graduate School of Medicine, Japan.
authors.forename: Yuki
authors.initials: Y
authors.lastname: Nakada
authors.affiliation: Aomori Rosai Hospital, Japan.
authors.forename: Toshihiro
authors.initials: T
authors.lastname: Suda
authors.affiliation: Department of Endocrinology and Metabolism, Hirosaki University Graduate School of Medicine, Japan Department of Endocrinology and Metabolism, Hirosaki University Graduate School of Medicine, Japan.
authors.forename: Makoto
authors.initials: M
authors.lastname: Daimon
mesh_terms: D000324:Adrenocorticotropic Hormone / Q000494:pharmacology*; D000450:Aldosterone / Q000097:blood; D006801:Humans; D006854:Hydrocortisone / Q000097:blood; D006929:Hyperaldosteronism / Q000097:blood / Q000175:diagnosis*; D008875:Middle Aged; D012372:ROC Curve; D011933:Reagent Kits, Diagnostic; D015203:Reproducibility of Results
chemical_list: D011933:Reagent Kits, Diagnostic; D000450:Aldosterone; D000324:Adrenocorticotropic Hormone; D006854:Hydrocortisone
keywords: Primary aldosteronism; adrenal venous sampling; adrenocorticotropin test; aldosterone-to-renin ratio; confirmatory test