ESPE Yearbook of Paediatric Endocrinology

Hormones (Athens). 2024; 23(4):765-775. PMID: 39052132 doi: 10.1007/s42000-024-00583-6. https://pubmed.ncbi.nlm.nih.gov/39052132/

Brief summary: This systematic review and meta-analysis found a significant increase in plasma aldosterone concentrations in healthy subjects after ACTH stimulation, irrespective of the ACTH dose.

Comment: It is infrequently reported that ACTH, in addition to the renin-angiotensin-aldosterone system (RAAS), is a potent aldosterone stimulator. While RAAS is the primary regulator of aldosterone in normal physiological conditions, ACTH plays a crucial role in modulating this response, especially in the adrenal gland (1). The precise role of ACTH in RAAS is not fully elucidated. It has been shown that ACTH primarily regulates aldosterone production in the short term, particularly during acute stress or in conditions like primary aldosteronism (1).

These authors performed a systematic search of PubMed, Medline, and Google Scholar databases according to PRISMA guidelines and meta-analysis. The presented data indicate that even low doses of ACTH are adequate to stimulate aldosterone secretion. This suggests a potential contribution to conditions associated with increased ACTH concentrations on aldosterone secretion regulation beyond the renin-angiotensin-aldosterone axis. In addition, age-related differences in aldosterone plasma concentration alterations after ACTH stimulation have been reported (2). As the incidence of hypertension increases with age, the contribution of ACTH to aldosterone secretion in older subjects should be determined via further research. Establishing a normal aldosterone response threshold following standardized ACTH stimulation could aid in identifying individuals with ACTH-dependent aldosterone hypersecretion and guide personalized and effective treatment strategies.

References: 1. El Ghorayeb N, Bourdeau I and Lacroix A (2016) Role of ACTH and Other Hormones in the Regulation of Aldosterone Production in Primary Aldosteronism. Front. Endocrinol. 7:72. doi: 10.3389/fendo.2016.000722. Morimoto, S., Takeda, R., Uchida, K., Miyamori, I., Miyamoto, M., Mimou, N. and Kigoshi, T. (1980), Reduced Aldosterone Secretory Response to Acute ACTH Stimulation in Sodium-Restricted Elderly Subjects. Journal of the American Geriatrics Society, 28: 361-366. https://doi.org/10.1111/j.1532-5415.1980.tb01099.x