ACTH Stimulation Maximizes the Accuracy of Peripheral Steroid Profiling in Primary Aldosteronism Subtyping

Autor: Adina F. Turcu, Ryo Morimoto, Hironobu Sasano, Aaron M. Udager, Lili Zhao, Kae Ishii, Fumitoshi Satoh, Yuta Tezuka, Yuto Yamazaki
Jazyk: angličtina
Rok vydání: 2021
Předmět:
Adult
Male
medicine.medical_specialty
endocrine system
Hydrocortisone
Endocrinology
Diabetes and Metabolism
Receptor expression
Clinical Biochemistry
030209 endocrinology & metabolism
Context (language use)
Adrenocorticotropic hormone
030204 cardiovascular system & hematology
Biochemistry
Online Only Article
Diagnostic Techniques
Endocrine
03 medical and health sciences
chemistry.chemical_compound
0302 clinical medicine
Endocrinology
Primary aldosteronism
Adrenocorticotropic Hormone
Corticosterone
Predictive Value of Tests
Cosyntropin
Internal medicine
Hyperaldosteronism
medicine
Humans
Aldosterone
Aged
Adrenal cortex
business.industry
Biochemistry (medical)
Middle Aged
medicine.disease
Stimulation
Chemical
medicine.anatomical_structure
chemistry
Female
Steroids
business
hormones
hormone substitutes
and hormone antagonists
Zdroj: J Clin Endocrinol Metab
Popis: ContextAdrenocorticotropic hormone (ACTH) can contribute to aldosterone excess in primary aldosteronism (PA) via increased melanocortin type 2 receptor expression. Dynamic manipulation of the hypothalamic-pituitary-adrenal (HPA) axis could assist PA subtyping, but a direct comparison of dynamic tests is lacking.ObjectiveTo investigate plasma steroid differences between aldosterone-producing adenoma (APA) and bilateral PA (BPA) relative to ACTH variations.MethodsWe conducted comprehensive dynamic testing in 80 patients: 40 with APA and 40 with BPA. Peripheral plasma was collected from each patient at 6 time points: morning; midnight; after 1 mg dexamethasone suppression; and 15, 30, and 60 minutes after ACTH stimulation. We quantified 17 steroids by mass spectrometry in response to ACTH variations in all patients and compared their discriminative power between the 2 PA subtypes.ResultsPatients with APA had higher morning and midnight concentrations of 18-hydroxycortisol, 18-oxocortisol, aldosterone, and 18-hydroxycorticosterone than those with BPA (P ConclusionSteroid differences between APA and BPA are enhanced by dynamic HPA testing; such noninvasive tests could circumvent the need for adrenal vein sampling in a subset of patients with PA.
Databáze: OpenAIRE
Externí odkaz: