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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
Author(s) -
StJean Matthieu,
Bourdeau Isabelle,
Therasse Éric,
Lacroix André
Publication year - 2020
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.14137
Subject(s) - aldosterone , primary aldosteronism , medicine , endocrinology , basal (medicine) , adrenocorticotropic hormone , context (archaeology) , chemistry , biology , hormone , paleontology , insulin
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 (PAC max ), and PAC/C ratio (PAC max /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). PAC max , PAC max /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), PAC max (AUC: 0.753 95% IC: 0.646‐0.860) and PAC max /C (AUC: 0.750 95% IC: 0.646‐0.853). Conclusion P mean basal PAC and PAC max and PAC max /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.