Plasma aldosterone response to ACTH stimulation test for diagnosis of primary aldosteronism: a cross-sectional study

• Published in: BMC endocrine disorders Vol. 24; no. 1; p. 37
• Main Authors: Manosroi, Worapaka, Atthakomol, Pichitchai, Inthaphan, Piti, Hintong, Supornthip
• Format: Journal Article
• Language: English
• Published: England BioMed Central Ltd 13.03.2024; BioMed Central; BMC
• Subjects: ACTH; ACTH stimulation test; Adrenal glands; Adrenocorticotropic Hormone; Aldosterone; Analysis; Cross-Sectional Studies; Diagnosis; Fludrocortisone; Hormones; Humans; Hyperaldosteronism; Hyperaldosteronism - complications; Hypertension; Hypertension - complications; Medical research; Medical tests; Medicine, Experimental; Normal distribution; Plasma; Potassium; Primary aldosteronism; Renin; Serum aldosterone; Serum cortisol; Statistical analysis; Germany; ACTH stimulation test; Primary aldosteronism; Serum aldosterone; Serum cortisol
• ISSN: 1472-6823; 1472-6823
• DOI: 10.1186/s12902-024-01563-y

The diagnosis of primary aldosteronism (PA) requires screening and confirmation testing. The present study examined whether the 1 µg ACTH stimulation test for plasma aldosterone concentration (PAC) can accurately diagnose PA by bypassing the regular confirmatory steps of PA diagnosis. A cross-sectional study with a total of 36 patients with an aldosterone-renin ratio (ARR) > 20 ng/dL per ng/m/hr were included. The confirmation test for PA was performed by saline infusion and the patients were categorized into PA and non-PA. PAC was collected at 20 and 40 min after 1 µg ACTH stimulation test. Multivariable logistic regression analysis was performed, and the associations are presented as odds ratios (OR) and 95% confidence intervals (CI). Diagnostic accuracy is presented as AuROC. Multivariable analysis found only PAC at 20 min after ACTH stimulation showed significant association with a diagnosis of PA (OR 1.18, 95%CI (0.99, 1.31), p = 0.040). AuROC for this value was 0.95 and the proposed cut-off was 52 ng/dL with a sensitivity of 71.4% and a specificity of 96.6%. Diagnosing PA may be aided by PAC at 20 min following 1 µg ACTH stimulation. This value may be used with patients for whom the confirmation test for PA cannot be conducted.