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Reassessment of the cosyntropin stimulation test in the confirmatory diagnosis and subtype classification of primary aldosteronism
Author(s) -
Umakoshi Hironobu,
Xiaomei Yang,
Ichijo Takamasa,
Kamemura Kohei,
Matsuda Yuichi,
Fujii Yuichi,
Kai Tatsuya,
Fukuoka Tomikazu,
Sakamoto Ryuichi,
Ogo Atsushi,
Suzuki Tomoko,
Ogasawara Tatsuki,
Tsuiki Mika,
Naruse Mitsuhide
Publication year - 2017
Publication title -
clinical endocrinology
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 1.055
H-Index - 147
eISSN - 1365-2265
pISSN - 0300-0664
DOI - 10.1111/cen.13167
Subject(s) - cosyntropin , primary aldosteronism , medicine , aldosterone , stimulation , endocrinology , adrenocorticotropic hormone , hormone
Summary Objective Although corticotropin is a representative secretagogue of aldosterone, the utility of the cosyntropin stimulation test (C‐ ST ) in diagnosing primary aldosteronism ( PA ) has not been elucidated. Aim of the study was to evaluate the clinical utility of C‐ ST for confirmatory testing and subtype classification of PA . Design, Setting and Patients In this retrospective study, we identified patients with hypertension and positive case‐detection results for PA who underwent C‐ ST and saline infusion testing ( SIT ) between 2006 and 2013 at eight referral centres in Japan. PA and essential hypertension ( EH ) were distinguished based on SIT results. PA subtype classification was determined by adrenal venous sampling ( AVS ). Plasma aldosterone concentration ( PAC ) was measured before and 30 and 60 min after intravenous cosyntropin administration. The ability of C‐ ST to distinguish PA from EH and to distinguish unilateral from bilateral disease was assessed by the area under the receiver operating characteristic curve. Results Of 205 patients with hypertension and positive case‐detection results, 139 (68%) had PA based on SIT results. Eighteen patients in whom AVS was unsuccessful were excluded from analysis. The baseline PAC before C‐ ST was significantly higher ( P < 0·01) in patients with PA than in those with EH . However, the degree of difference in PAC between patients with PA and EH was not enhanced by the administration of cosyntropin. In addition, the administration of cosyntropin did not improve the distinction between bilateral and unilateral PA subtypes. Conclusions C‐ ST has no utility as a confirmatory and subtype testing of PA when the diagnosis of PA is based on the positive results in SIT .