Diagnostic Value of ACTH Stimulation Test in Determining the Subtypes of Primary Aldosteronism

Jiang, Yiran; Zhang, Cui; Wang, Weiqing; Su, Tingwei; Zhou, Weiwei; Jiang, Lei; Zhu, Wei; Xie, Jing; Ning, Guang

doi:10.1210/jc.2014-3551

Cited by 41 publications

(70 citation statements)

References 36 publications

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“…After our report, another group has performed a similar study analyzing the diagnostic capacity of ACTH stimulation test under dexamethasone suppression to diagnose APA, with the result consistent with ours in that the test is useful for detecting unilateral PA 22 . There have also been studies that tested the efficiency of ACTH stimulation test without dexamethasone suppression, but they were not so successful in differentiating the two major subtypes in PA patients 23,24 , suggesting the importance of dexamethasone administration.…”

Section: Differential Regulation Of Blood Aldosterone Level In Apa Ansupporting

confidence: 84%

Regulatory Role of ACTH on Aldosterone in Aldosterone-Producing Adenoma

Sone¹

2017

J Rare Dis Res Treat

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Primary aldosteronism (PA), one of the most frequent causes of secondary hypertension, is mainly composed of two major subtypes: aldosteroneproducing adenoma (APA) and bilateral hyperaldosteronism (BHA). In APA, ACTH plays a dominant role in the regulation of circulating aldosterone level, while in physiological condition and BHA angiotensin II has a stronger effect. This pronounced regulation of aldosterone by ACTH in APA causes a differential response of aldosterone to either ACTH stimulation or ACTH suppression in APA from that in physiological condition and BHA, and therefore, ACTH stimulation test can be informative in differentiating APA among patients with PA and essential hypertension. Histologic studies have suggested a possibility that the origin of APA especially consisting of clear, lipid rich cells could be zona fasticulata, rather than zona glomerulosa. Recent studies have been focusing on molecular classification among APA, which could lead to a better understanding of ACTH responsiveness in APA.

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Section: Differential Regulation Of Blood Aldosterone Level In Apa Ansupporting

confidence: 84%

Regulatory Role of ACTH on Aldosterone in Aldosterone-Producing Adenoma

Sone¹

2017

J Rare Dis Res Treat

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“…The present data showed that the AST had the highest positive rate among all confirmatory tests in both the unilateral and bilateral groups. Sonoyama et al and Jiang et al reported that the ACTH stimulation test under dexamethasone suppression is highly sensitive for distinguishing APA from IHA or non-PA [12,13]. In this study, the AST-positive rate was not different between the groups using a cut-off value of 8.5 for PAC max /F in AST [9].…”

Section: Discussionmentioning

confidence: 60%

“…However, AVS is far from easy to perform for all patients with PA because of some problems (e.g., high cost, adrenal phlebography-associated complications, and the high level of technical skill and experience needed for successful cannulation of the (right) adrenal vein). Recent reports have shown that the ACTH stimulation test with 1-mg dexamethasone is useful for determining the subtype of PA [12,13]. However, little has been reported about which confirmatory tests are useful in determining the subtype of PA. Our objective was to determine the most useful confirmatory test and the cut-off value to distinguish the subtype of PA.…”

Section: Astmentioning

confidence: 99%

“…While there have been several reports of discriminating between lateral and bilateral hypersecretion in PA using AST with dexamethasone [12,13] and without dexamethasone [23], AST is still controversial in the diagnosis of PA. Next, previous studies reported varying prevalences of lateral lesions. Nishikawa et al reported that among their 65 patients with PA, the proportions of APmacroA and APmicroA were 32.3% and 33.8%, respectively, and APA predominated [6], while Young et al reported that APA and IHA were distributed almost equally (APA, 53%; IHA, 43%) [26].…”

Section: Disclosurementioning

confidence: 99%

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ACTH stimulation test and computed tomography are useful for differentiating the subtype of primary aldosteronism

et al. 2017

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“…The diagnostic accuracy was around 80-90%, so this test might be used to select patients who have high probability of unilateral disease and definitely require AVS [57,58].…”

Section: Clinical Management Of Adrenal Tumors 74mentioning

confidence: 99%

Rational Approach to a Patient with Suspected Primary Aldosteronism

Kocjan¹

2017

Clinical Management of Adrenal Tumors

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Primary aldosteronism (PA) is the most common form of secondary hypertension that causes higher morbidity and mortality than equally severe essential hypertension. Bilateral PA should be treated medically with spironolactone or eplerenone, the mineralocorticoid receptor antagonists (MRA), while unilateral laparoscopic adrenalectomy is recommended for unilateral disease. Surgery cures hypertension in around 40% of patients with confirmed PA and reliably demonstrated unilateral autonomous aldosterone secretion by adrenal venous sampling (AVS). Regardless of its diagnostic value, AVS has several drawbacks, in particular high cost and invasiveness. Furthermore, only a limited number of referral centers worldwide routinely carry out the procedure. On the other hand, a small number of studies that compared the effects of surgery and MRA on the incidence of cardiovascular and renal outcomes in patients with PA found no difference between the two therapeutic options. In addition, spironolactone has been recently found to be the most effective add-on drug for the treatment of resistant hypertension. Therefore, rational selection of patients with suspected PA for AVS and surgery is of utmost importance.Keywords: adrenalectomy, adrenal venous sampling, hypertension, mineralocorticoid receptor antagonists, primary aldosteronism IntroductionPrimary aldosteronism (PA) is a group of disorders in which aldosterone production is inappropriately high for sodium status, relatively autonomous and nonsuppressible by sodium loading. Such inappropriate production of aldosterone causes hypertension, sodium retention, suppression of plasma renin, and increased potassium excretion [1]. Once thought to be rare, PA is now considered the most common form of secondary hypertension with an © 2017 The Author(s). Licensee InTech. This chapter is distributed under the terms of the Creative Commons Attribution License (http://creativecommons.org/licenses/by/3.0), which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited. estimated prevalence of 4.3% in primary care and of 9.5% among referred hypertensive patients [2]. Accumulated experimental and clinical evidence clearly shows that prolonged exposure to elevated aldosterone levels causes excess cardiovascular and renal damage which is partly independent of blood pressure (BP) levels [3]. Consequently, this endocrine condition is far from being benign, and patients with PA appear to have higher rates of cardiac arrhythmia, coronary heart disease, heart failure, stroke, proteinuria, and renal impairment compared to matched patients with essential hypertension (EH) [4][5][6]. Their cardiovascular mortality might be also increased [7]. Targeted treatment of PA is possible and is of obvious benefit to affected patients.The Endocrine Society now explicitly recognizes PA as a major public health issue and recommends extensive screening for this disorder using the plasma aldosterone/renin ratio (ARR) in high-risk populations, inclu...

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Diagnostic Value of ACTH Stimulation Test in Determining the Subtypes of Primary Aldosteronism

Abstract: 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.

Cited by 41 publications

References 36 publications

Regulatory Role of ACTH on Aldosterone in Aldosterone-Producing Adenoma

Regulatory Role of ACTH on Aldosterone in Aldosterone-Producing Adenoma

ACTH stimulation test and computed tomography are useful for differentiating the subtype of primary aldosteronism

Rational Approach to a Patient with Suspected Primary Aldosteronism

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