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

Endocrine journal

Hideki Tamura¹  Naomi Takeichi-Hattori¹  Tomoko Nagamine¹  Kyoko Tanimura-Inagaki¹  Shunsuke Kobayashi¹  Masaaki Yamamoto¹  Taro Harada¹  Mototsugu Nagao¹  Ayako Moriya¹  Shinichi Oikawa¹  Hitoshi Sugihara¹  Satoru Murata²  Shiro Onozawa²  Izumi Fukuda³ 

[1] Department of Endocrinology, Diabetes and Metabolism, Graduate School of Medicine, Nippon Medical School, Tokyo 113-8603, Japan;Department of Radiology/Center for Advanced Medical Technology, Nippon Medical School, Tokyo 113-8603, Japan;Tamura Medical Clinic, Tokyo 132-0013, Japan

关键词: Primary aldosteronism;    Subtype;    ACTH stimulation test;    Computed tomography;    Saline infusion test;   

DOI  :  10.1507/endocrj.EJ16-0297

学科分类：内分泌与代谢学

来源: Japan Endocrine Society

【 摘 要 】

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.

【 授权许可】

Unknown