ESPE Abstracts

Adrenocorticotropic hormone (ACTH) in addition to renin-angiotensin- aldosterone axis is a potent aldosterone stimulator, suggesting a potential contribution in conditions associated with increased ACTH concentrations. This review aims to systematically review and synthesize the scientific evidence of alterations of plasma aldosterone concentrations in response to ACTH stimulation during the cosyntropin (Synacthen) test and define the range of aldosterone response. A systematic search of PubMed, Medline and Google Scholar databases according to PRISMA guidelines was performed. Only studies that assessed the alterations in plasma aldosterone concentrations following ACTH stimulation in healthy individuals were included. We incorporated studies that utilized the doses of 1μg, 250 μg, 0.125 μg/m² or 0.5 μg/m² of ACTH. Out of 1,599 initially assessed articles, 17 were deemed relevant to our research. The selected articles were assessed by two independent investigators based on the predetermined inclusion and exclusion criteria. Finally, 8 full-text articles were included. The analyzed studies revealed a significant increase in plasma aldosterone concentrations in healthy subjects after ACTH stimulation, irrespectively of the ACTH dose. The peak aldosterone concentration after the 250 μg dose occurred at 30 minutes, whereas smaller doses exhibited an earlier peak, at around 15 minutes. On average, plasma aldosterone concentration increased by 125.5% after the 1μg and 0.5 μg/m² doses, and by 189.6% after 250μg. The presented evidence strongly supports the contribution of ACTH in the aldosterone secretion regulation, beyond the renin-angiotensin-aldosterone axis. Establishing a normal aldosterone response threshold following standardized ACTH stimulation could aid in identifying individuals with ACTH-dependent aldosterone hyper-secretion and guide personalized and effective treatment strategies.