Clinical Utility of the Adrenocorticotropin Stimulation Test with/without Dexamethasone Suppression for Definitive and Subtype Diagnosis of Primary Aldosteronism

Abstract

The adrenocorticotropin (ACTH) stimulation test (AST) has been reported to be useful for diagnosing primary aldosteronism (PA), particularly for differentiating PA subtypes under 1-mg dexamethasone suppression (DS). The aim of our study was to clarify the effect of 1-mg DS on AST results. A retrospective cohort study was conducted using data for 48 patients (PA: 30/48). We estimated the difference in plasma aldosterone concentration (PAC) responsiveness to ACTH stimulation with single (AST alone) and combined (AST under 1-mg DS) tests within the same patient. We compared the diagnostic accuracy of these two tests for PA and the laterality of hyperaldosteronism. We found no differences in PAC responsiveness to ACTH stimulation between single and combined tests, and observed a significant positive linear relationship (30 min, R2 = 0.75, p-value < 0.01). Both tests showed the highest diagnostic accuracy for PA following 30 min of ACTH stimulation. The ability to detect the laterality of hyperaldosteronism was inconsistent and differed according to the two definitions: lateralization ratio and the absolute aldosterone levels in adrenal venous sampling. PAC responsiveness to ACTH stimulation was similar for AST with and without 1-mg DS. AST can be performed under both conditions with similar accuracy to detect PA.

Cortisol Co-Secretion and Clinical Usefulness of ACTH Stimulation Test in Primary Aldosteronism: A Systematic Review and Biases in Epidemiological Studies

“…We restricted studies to those with a sample size ≥10 (to avoid case reports) and written in English. Flow of studies through review and summary of the identified 9 studies are shown in Figure 1B and Table 2 (17)(18)(19)(49)(50)(51)(52)(53)(54).…”

“…In 1995, Stowasser et al reported higher plasma aldosterone response after ACTH stimulation under dexamethasone suppression among angiotensin II responsive APA (n=16) or angiotensin II unresponsive APA (n=11) compared with BAH (n=19) (55). Although several studies mostly from Japan have shown moderate to high predictive performance (area under the curve [AUC] ranges from 0.70 to 0.95) to differentiate APA from BAH by using ACTH stimulation test (17,18,(49)(50)(51)(52)54) over the last two decades, these findings are not comparable across studies due to the lack of uniformity in protocols in each study (e.g., ACTH dosage, with or without 1 mg DST, different cut-off time or values, etc), inconsistent definition of outcomes (e.g., diagnosis of APA and BAH based on AVS, histopathological findings, etc. ), and study design (sample size, single-center or multi-center, prospective or retrospective, etc.).…”

Evaluation of Cortisol Production in Aldosterone-Producing Adenoma

“…Plasma aldosterone concentration (PAC, ng/dl, × 27.7 for pmol/l), serum cortisol levels (F, μg/dl, × 27.6 for nmol/l), and adrenocorticotropic hormone (ACTH, pg/ml, × 0.220 for pmol/l) were measured using radioimmunoassay (RIA), chemiluminescent enzyme immunoassay (CLEIA), and electrochemiluminescent immunoassay, respectively [10,11]. Plasma renin activities (PRA, ng/ml/h) were measured using RIA until December, 2015, and enzyme immunoassay since January 2016 [12]. Dehydroepiandrosterone sulfate (DHEA-S, μg/dl, × 0.027 for μmol/l) was measured using RIA until December, 2014, and CLEIA since January 2015.…”

“…Dehydroepiandrosterone sulfate (DHEA-S, μg/dl, × 0.027 for μmol/l) was measured using RIA until December, 2014, and CLEIA since January 2015. Levels of PRA and DHEA-S measured using two different assays were confirmed to have a linear relationship (1:1) and hence were treated similarly in subsequent analysis [12]. We used the plasma aldosterone screening criterion as PAC/PRA ratio (ARR) > 20 for patients with a PRA ≤ 1.2 ng/ml/h and a PAC ≥ 10 ng/dl [11].…”

High‐sucrose diet potentiates hyperaldosteronism and renal injury induced by stress in young adult rats

“…Chronic restraint stress increases the adrenocorticotropin (ACTH), 1 which promotes an increase in the aldosterone levels 2 . Thus, stress could be an important cause of the increase in the aldosterone levels 3,4 .…”