Significance of Adrenocorticotropin Stimulation Test in the Diagnosis of an Aldosterone-Producing Adenoma

Sonoyama, Takuhiro; Sone, Masakatsu; Miyashita, Kazutoshi; Tamura, Naohisa; Yamahara, Kenichi; Park, Kwijun; Oyamada, Naofumi; Taura, Daisuke; Inuzuka, Megumi; Kojima, Ken-ichi; Honda, K.; Fukunaga, Yasutomo; Kanamoto, Naotetsu; Miura, Masako; Yasoda, Akihiro; Arai, Hiroshi; Itoh, Hiroshi; Nakao, Kazuwa

doi:10.1210/jc.2011-0573

Cited by 46 publications

(66 citation statements)

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“…In the present series, 82% of the patients in the unilateral group (14/17) had a macro adenoma and high PAC. These characteristics of the patients in the unilateral group might cause clearly elevated PAC and PAC/F at baseline in comparison with other studies [12,22,23]. The remarkably high PAC/F in the unilateral group persisted until 120 min after ACTH administration, and it might have led to the clinical usefulness of AST in differentiating the subtype of PA. Terui et al reported that PAC max was more useful than PAC max /F in AST without dexamethasone suppression for differentiating between APA patients and other patients [23].…”

Section: Discussionmentioning

confidence: 48%

“…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: 61%

“…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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Section: Discussionmentioning

confidence: 48%

Section: Discussionmentioning

confidence: 61%

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confidence: 99%

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

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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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Confirmatory Testing for Primary Aldosteronism

Grüber

Gao

Vonend

et al. 2014

Primary Aldosteronism

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Significance of Adrenocorticotropin Stimulation Test in the Diagnosis of an Aldosterone-Producing Adenoma

Abstract: Our study indicates that the ACTH stimulation test is useful in the diagnosis of an APA among patients suspected of PA. This test can be used to select patients who are highly suspected of an APA and definitely require adrenal venous sampling.

Cited by 46 publications

References 40 publications

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

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

Rational Approach to a Patient with Suspected Primary Aldosteronism

Confirmatory Testing for Primary Aldosteronism

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