Skip to main page content
U.S. flag

An official website of the United States government

Dot gov

The .gov means it’s official.
Federal government websites often end in .gov or .mil. Before sharing sensitive information, make sure you’re on a federal government site.

Https

The site is secure.
The https:// ensures that you are connecting to the official website and that any information you provide is encrypted and transmitted securely.

Access keys NCBI Homepage MyNCBI Homepage Main Content Main Navigation
. 2024 Mar 13;24(1):37.
doi: 10.1186/s12902-024-01563-y.

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

Worapaka Manosroi  1   2 , Pichitchai Atthakomol  3   4 , Piti Inthaphan  5 , Supornthip Hintong  6
Affiliations

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

Worapaka Manosroi et al. BMC Endocr Disord. .

Abstract

Background: 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.

Methods: 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.

Results: 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%.

Conclusions: 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.

Keywords: ACTH stimulation test; Primary aldosteronism; Serum aldosterone; Serum cortisol.

PubMed Disclaimer

Conflict of interest statement

Authors declare that there is no conflict of interest that could be perceived as prejudicing the impartiality of the research reported.

Figures

Fig. 1
Fig. 1
AuROC of plasma aldosterone concentration 20 min after ACTH stimulation test
Fig. 2
Fig. 2
Standards for reporting of diagnostic accuracy (STARD) flow diagram of the study
See this image and copyright information in PMC

References

    1. Brown JM, Siddiqui M, Calhoun DA, Carey RM, Hopkins PN, Williams GH, Vaidya A. The unrecognized prevalence of primary aldosteronism: a cross-sectional study. Ann Intern Med. 2020;173(1):10–20. doi: 10.7326/M20-0065. - DOI - PMC - PubMed
    1. Funder JW, Carey RM, Mantero F, Murad MH, Reincke M, Shibata H, Stowasser M, Young WF. Jr: the management of primary aldosteronism: case detection, diagnosis, and treatment: an endocrine Society Clinical Practice Guideline. J Clin Endocrinol Metabolism. 2016;101(5):1889–916. doi: 10.1210/jc.2015-4061. - DOI - PubMed
    1. Mulatero P, Milan A, Fallo F, Regolisti G, Pizzolo F, Fardella C, Mosso L, Marafetti L, Veglio F, Maccario M. Comparison of confirmatory tests for the diagnosis of primary aldosteronism. J Clin Endocrinol Metab. 2006;91(7):2618–23. doi: 10.1210/jc.2006-0078. - DOI - PubMed
    1. Nanba K, Tsuiki M, Umakoshi H, Nanba A, Hirokawa Y, Usui T, Tagami T, Shimatsu A, Suzuki T, Tanabe A, et al. Shortened saline infusion test for subtype prediction in primary aldosteronism. Endocrine. 2015;50(3):802–6. doi: 10.1007/s12020-015-0615-9. - DOI - PubMed
    1. Hattangady NG, Olala LO, Bollag WB, Rainey WE. Acute and chronic regulation of aldosterone production. Mol Cell Endocrinol. 2012;350(2):151–62. doi: 10.1016/j.mce.2011.07.034. - DOI - PMC - PubMed