ACTH兴奋试验在原发性醛固酮增多症单双侧分型鉴别中的价值探讨OA

Objective To investigate the clinical value of 1 mg dexamethasone combined with the adrenocorticotropic hormone(ACTH)stimulation test in the differential diagnosis of unilateral and bilateral subtypes of primary aldosteronism(PA).Methods A retrospective analysis was conducted on the clinical data of PA patients who underwent the ACTH stimulation test at the Department of Endocrinology,the First Medical Center of Chinese PLA General Hospital,between January 1,2020,and April 30,2024.A total of 360 patients with PA were definitively diagnosed through a comprehensive evaluation,including surgical pathology,adrenal venous sampling(AVS),imaging features,clinical characteristics,and treatment response.These patients were classified into unilateral primary aldosteronism(UPA,n=167)and bilateral primary aldosteronism(BPA,n=193);and according to ACTH dosage,they were divided into 25 U ACTH group(n=136)and 50 U ACTH group(n=224).The levels of plasma aldosterone(PAC)and the ratio of plasma aldosterone to concurrent plasma cortisol(F)(PAC/F)at 30,60,90,and 120 minutes after ACTH stimulation were compared among the different groups.Receiver operating characteristic(ROC)curves were plotted,and the diagnostic performance of the ACTH stimulation test in distinguishing UPA from BPA and other types of PA was analyzed.Results No significant differences were observed in the PAC and PAC/F at each time point during the ACTH stimulation test between 25 U ACTH group and 50 U ACTH group(P>0.05).The area under the ROC curve(AUC)for PAC values used to differentiate UPA from BPA was highest at 90 min(0.94),with an optimal cut-off point of 37.85 ng/dl.In unilateral lesions,the AUC of PAC values for differentiating adrenal adenoma(APA)from unilateral adrenal hyperplasia(UAH)was highest at 120 min(0.826),with an optimal cut-off point of 58.65 ng/dl.The AUC of PAC values for differentiating APA from BPA was highest at 90 min(0.961),with an optimal cut-off point of 39.05 ng/dl.The AUC of PAC values for differentiating UAH from BPA was highest at 60 min(0.889),with an optimal cut-off point of 39.25 ng/dl.Conclusions The 1 mg dexamethasone combined with 25 U ACTH stimulation test has similar diagnostic cut-offs for distinguishing UPA from BPA as the 50 U ACTH test.The ACTH stimulation test can be used not only for the differentiation of UPA and BPA but also for the differential diagnosis of various subtypes within unilateral and bilateral PA.