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 |
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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 |
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