Plasma Aldosterone Response to ACTH in Primary Aldosteronism and in Patients with Low Renin Hypertension*

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Abstract
ACTH.alpha.1-24 was infused at incremental rates of 12.5-200 mIU/30 min in dexamethasone-suppressed hypertensive patients on a regular Na diet. The plasma aldosterone response to this stimulus in 8 patients with hyperaldosteronism due to an adrenal adenoma and 11 with adrenal hyperplasia was significantly greater at all infusion rates (P < 0.05) when compared with the response in 6 normal subjects on a similar diet. This responsiveness to ACTH in the patients with primary hyperaldosteronism was similar to that of the normal subjects on a low Na diet. Some 12 patients with low renin and 6 patients with normal renin essential hypertension were similarly studied. There was no significant difference in the median aldosterone response between these 2 groups and the normal subjects on a normal diet, but the response was significantly lower compared with that in patients with primary hyperaldosteronism. Patients with hyperaldosteronism from an adrenal adenoma or hyperplasia apparently have a consistent and exaggerated response to ACTH. The hyper-responsiveness is not apparently shared by the majority of patients with low renin essential hypertension and does not support the concept that this group is an intermediate form of primary aldosteronism. Individual patients within this group may have such a response and might be identified by this type of testing.