Yiran Jiang1, Cui Zhang, Weiqing Wang, Tingwei Su, Weiwei Zhou, Lei Jiang, Wei Zhu, Jing Xie, Guang Ning. 1. Shanghai Key Laboratory for Endocrine Tumors (Y.J., C.Z., W.W., T.S., W.Zhou., L.J., W.Zhu., G.N.), Shanghai Clinical Center for Endocrine and Metabolic Diseases, Shanghai Institute of Endocrine and Metabolic Diseases and Shanghai E-Institute for Endocrinology, Ruijin Hospital, Shanghai Jiaotong University, School of Medicine, Shanghai Key Laboratory for Endocrine Tumors (Y.J., C.Z., W.W., T.S., W.Zhou., L.J., W.Zhu., G.N.), Shanghai Clinical Center for Endocrine and Metabolic Diseases, Key Laboratory for Endocrine and Metabolic Diseases of Chinese Health Ministry, Ruijin Hospital Affiliated to Shanghai JiaoTong University School of Medicine, Laboratory for Endocrine and Metabolic Diseases of Institute of Health Science (W.W., G.N.), Shanghai JiaoTong University School of Medicine and Shanghai Institutes for Biological Sciences, Chinese Academy of Sciences, and Department of Pathology (J.X.), Ruijin Hospital affiliated to Shanghai Jiaotong University School of Medicine, Shanghai 200025, People's Republic of China.
Abstract
BACKGROUND: Adrenal venous sampling is recommended as the golden standard for subtyping primary aldosteronism (PA). However, it is invasive and inconvenient, and seeking a better way to make differential diagnosis of PA is necessary. OBJECTIVE: The objective of the study was to evaluate the diagnostic value of ACTH stimulation test under 1 mg dexamethasone suppression test (DST) in determining the subtypes of PA. METHODS: Ninety-five patients with PA confirmed by saline infusion test were included in this study. According to adrenal venous sampling and histopathology, 39 patients were diagnosed as bilateral adrenal hyperplasia (BAH), 37 as aldosterone-producing adenoma (APA), and 19 as unilateral adrenal hyperplasia (UAH). An ACTH stimulation test under 1 mg DST was performed in all patients. Plasma aldosterone and cortisol levels were measured every 30 minutes until 120 minutes after the iv injection of 50 IU ACTH. RESULTS: During the ACTH stimulation test, aldosterone levels in APA and UAH were similar (P > .05) but higher than those in BAH (P < .001). Furthermore, stimulated aldosterone levels of unilateral PA (APA and UAH) were significantly higher than bilateral PA (BAH) (P < .001). Receiver-operated characteristics curve analyses showed the aldosterone after ACTH stimulation was effective for distinguishing between unilateral PA and bilateral PA. The diagnostic accuracy was highest at 120 minutes after ACTH stimulation, and the optimal cutoff value of the aldosterone was 77.90 ng/dL, with a sensitivity of 76.8%, a specificity of 87.2%, a positive predictive value of 89.6%, and a negative predictive value of 72.3%. CONCLUSIONS: 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.
BACKGROUND: Adrenal venous sampling is recommended as the golden standard for subtyping primary aldosteronism (PA). However, it is invasive and inconvenient, and seeking a better way to make differential diagnosis of PA is necessary. OBJECTIVE: The objective of the study was to evaluate the diagnostic value of ACTH stimulation test under 1 mg dexamethasone suppression test (DST) in determining the subtypes of PA. METHODS: Ninety-five patients with PA confirmed by saline infusion test were included in this study. According to adrenal venous sampling and histopathology, 39 patients were diagnosed as bilateral adrenal hyperplasia (BAH), 37 as aldosterone-producing adenoma (APA), and 19 as unilateral adrenal hyperplasia (UAH). An ACTH stimulation test under 1 mg DST was performed in all patients. Plasma aldosterone and cortisol levels were measured every 30 minutes until 120 minutes after the iv injection of 50 IU ACTH. RESULTS: During the ACTH stimulation test, aldosterone levels in APA and UAH were similar (P > .05) but higher than those in BAH (P < .001). Furthermore, stimulated aldosterone levels of unilateral PA (APA and UAH) were significantly higher than bilateral PA (BAH) (P < .001). Receiver-operated characteristics curve analyses showed the aldosterone after ACTH stimulation was effective for distinguishing between unilateral PA and bilateral PA. The diagnostic accuracy was highest at 120 minutes after ACTH stimulation, and the optimal cutoff value of the aldosterone was 77.90 ng/dL, with a sensitivity of 76.8%, a specificity of 87.2%, a positive predictive value of 89.6%, and a negative predictive value of 72.3%. CONCLUSIONS: 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.
Authors: Adina F Turcu; Taweesak Wannachalee; Alexander Tsodikov; Aya T Nanba; Jianwei Ren; James J Shields; Patrick J O'Day; Donald Giacherio; William E Rainey; Richard J Auchus Journal: Hypertension Date: 2019-12-02 Impact factor: 10.190
Authors: Jana Katharina Wrosch; Bastian Volbers; Philipp Gölitz; Daniel Frederic Gilbert; Stefan Schwab; Arnd Dörfler; Johannes Kornhuber; Teja Wolfgang Groemer Journal: Front Neurol Date: 2015-11-19 Impact factor: 4.003
Authors: Jung Soo Lim; Samuel W Plaska; Juilee Rege; William E Rainey; Adina F Turcu Journal: Front Endocrinol (Lausanne) Date: 2021-03-16 Impact factor: 5.555