Use of peripheral plasma aldosterone concentration and response to ACTH during simultaneous bilateral adrenal veins sampling to predict the source of aldosterone secretion in primary aldosteronism.

Abstract:

CONTEXT:Previous studies suggested that plasma aldosterone (PAC) response to ACTH stimulation could predict the subtypes of primary aldosteronism (PA) and avoid adrenal venous sampling (AVS). OBJECTIVE:Assess the usefulness of peripheral (P) PAC response to ACTH stimulation during AVS to identify the source of aldosterone in patients with PA. METHODS:Two hundred and fifteen patients were assigned to four different lateralization ratio (LR) groups based on different combinations of basal (≥ or <2) and post-ACTH LR (≥ or <4). The P vein parameters analysed included as follows: mean basal PAC, maximal PAC (PACmax ), and PAC/C ratio (PACmax /C), PAC absolute increase, PAC relative increase following ACTH bolus (250 mcg IV) and maximal variation of PAC/C ratio between post-ACTH and basal measures. RESULTS:Mean basal PAC was significantly higher in group 1 (basal LR > 2 and post-ACTH > 4) than in group 2 (basal LR > 2, post-ACTH < 4) or group 4 (basal LR < 2 post-ACTH < 4) (P < .001). PACmax , PACmax /C and PAC absolute increase following ACTH were higher in group 1 than the others (P < .017). Using receiver operating characteristic (ROC) curves analysis of groups 1 and 4, best AUC were obtained with mean basal PAC (AUC: 0.757 95% IC: 0.653-0.861), PACmax (AUC: 0.753 95% IC: 0.646-0.860) and PACmax /C (AUC: 0.750 95% IC: 0.646-0.853). CONCLUSION:P mean basal PAC and PACmax and PACmax /C are higher in basal and ACTH lateralized PA than in other groups. Peripheral PAC cut-off values fail to adequately distinguish all groups and cannot replace the requirement to conduct AVS.

journal_name

Clin Endocrinol (Oxf)

journal_title

Clinical endocrinology

authors

St-Jean M,Bourdeau I,Therasse É,Lacroix A

doi

10.1111/cen.14137

subject

Has Abstract

pub_date

2020-03-01 00:00:00

pages

187-195

issue

3

eissn

0300-0664

issn

1365-2265

journal_volume

92

pub_type

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