title: ACTH stimulation test and computed tomography are useful for differentiating the subtype of primary aldosteronism.
abstract: The diagnostic steps for primary aldosteronism (PA) include case screening tests, confirmatory tests, and localization. The aim of this study was to identify useful confirmatory tests and their cut-off values for differentiating the subtype of primary aldosteronism, especially in unilateral PA, such as aldosterone-producing adenoma, and bilateral PA, such as idiopathic hyperaldosteronism. Seventy-six patients who underwent all four confirmatory tests, the captopril-challenge test (CCT), furosemide upright test (FUT), saline infusion test (SIT), and ACTH stimulation test (AST), and who were confirmed to have an aldosterone excess by adrenal venous sampling (AVS) were recruited. Subjects were diagnosed as having unilateral aldosterone excess (n=17) or bilateral aldosterone excess (n=59) by AVS. The SIT-positive rate was significantly higher in the unilateral group (94.1%) than in the bilateral group (57.6%). Multivariable logistic regression analysis showed that tumor on computed tomography (CT) and plasma aldosterone concentration (PAC)max/cortisol on the AST were useful for differentiating the subtype of PA. Receiver operating characteristic (ROC) curve analysis for distinguishing the subtype of PA showed that a cut-off value of 18.3 PACmax/cortisol on the AST had a sensitivity of 83% and a specificity of 88%. The area under the ROC curve was 0.918 (95% confidence interval 0.7916-0.9708). These data suggest that abdominal CT and AST are useful for differentiating the subtype of PA and the indication for AVS.
authors.affiliation: Department of Endocrinology, Diabetes and Metabolism, Graduate School of Medicine, Nippon Medical School, Tokyo 113-8603, Japan.
authors.forename: Ayako
authors.initials: A
authors.lastname: Moriya
authors.forename: Masaaki
authors.initials: M
authors.lastname: Yamamoto
authors.forename: Shunsuke
authors.initials: S
authors.lastname: Kobayashi
authors.forename: Tomoko
authors.initials: T
authors.lastname: Nagamine
authors.forename: Naomi
authors.initials: N
authors.lastname: Takeichi-Hattori
authors.forename: Mototsugu
authors.initials: M
authors.lastname: Nagao
authors.forename: Taro
authors.initials: T
authors.lastname: Harada
authors.forename: Kyoko
authors.initials: K
authors.lastname: Tanimura-Inagaki
authors.forename: Shiro
authors.initials: S
authors.lastname: Onozawa
authors.forename: Satoru
authors.initials: S
authors.lastname: Murata
authors.forename: Hideki
authors.initials: H
authors.lastname: Tamura
authors.forename: Izumi
authors.initials: I
authors.lastname: Fukuda
authors.forename: Shinichi
authors.initials: S
authors.lastname: Oikawa
authors.forename: Hitoshi
authors.initials: H
authors.lastname: Sugihara
mesh_terms: D000324:Adrenocorticotropic Hormone / Q000627:therapeutic use*; D000328:Adult; D000368:Aged; D000450:Aldosterone / Q000097:blood; D003937:Diagnosis, Differential; D003940:Diagnostic Techniques, Endocrine / Q000592:standards; D005260:Female; D006801:Humans; D006854:Hydrocortisone / Q000097:blood; D006929:Hyperaldosteronism / Q000145:classification* / Q000175:diagnosis* / Q000000981:diagnostic imaging; D008297:Male; D008875:Middle Aged; D011237:Predictive Value of Tests; D012016:Reference Values; D012189:Retrospective Studies; D012680:Sensitivity and Specificity; D014057:Tomography, X-Ray Computed
chemical_list: D000450:Aldosterone; D000324:Adrenocorticotropic Hormone; D006854:Hydrocortisone