Marjorie A. Ramos,
Jocelyn Jayme-Wohldorf Related Institution
Journal Article, Original
Philippine Journal of Internal Medicine
Date of Publication
OBJECTIVE: To describe the 1 hour ACTH stimulation test characteristics, low-dose (1 meg) and high-dose (250 meg), in Filipinos. To determine whether there is a difference in the 30-minute and 60-minute stimulated cortisol value in the low-dose and the high-dose ACTH stimulation tests. To determine whether a baseline cortisol cut-off value can predict patients with adrenal insufficiency.
METHODS: Of the 123 ACTH stimulation tests (83, low-dose, 40 high dose) performed from January 2004-August 2006, 111 tests were analyzed. Serum cortisol were extracted at baseline, then at 30 and 60 minutes after injection of corticotropin for both the high and low-dose test. Cortisol >18 mcg/dl before or after ACTH stimulation is suggestive of normal adrenal function. Cortisol _<18 is positive for the test. We analyzed the different changes in serum cortisol in the 30 and 60 minutes stimulated value in the low and high-dose ACTH stimulation test. The independent T-test and the chi square or Fisher's exact test were used to determine differences in baseline characteristics between the high and low-dose groups. The McNemar change test was used to determine significant changes in the values before and after stimulation test.
RESULTS: In both High and Low dose ACTH stimulation test, absolute mean changes were highly significant from baseline to 30 mins (p<0.001) and from baseline to 60 mins (p<0.001) but not from 30 to 60 mins (p=0.397 high-dose; p=0.116 low dose). A baseline cortisol of < 3 resulted in a maximum stimulated value of < 18, 100 percent and 78.6 percent of the time in the high and low-dose test respectively.
CONCLUSION: With the High Dose ACTH Stimulation Test, 30 minute and 60 minute cortisol values were very similar with very minimal increments. The low-dose ACTH stimulation test revealed variable results between the 30 minute and 60 minute values, often with lower values at the 60th minute. A baseline cortisol level < 3 is predictable for maximal cortisol stimulation to < 18 for both the high and low-dose ACTH stimulation test. (Author)
1. Mayenknecht, J , Diederich, S , Bahr, V . Comparison of low and high dose corticotropin stimulation tests in patients with pituitary disease
Journal Clinical Endocrinology Metabolism 85(5): 1998
2. Gonzalez, J G, Hernandez, N E. A High sensitivity test in the assessment of adrenocortical insuficiency: 10 ug vs 250 ug corticotrophin dose assessment of adrenal insuficiency
Journal of Endocrinology 159, 275, 1998
3. Bangar, V , Clayton, R N. How reliable is the short synacten test for the investigation of the hypothalamic-pituitary adrenal axis?
European Journal Endocrinology 139, 580, 1998
4. Zarkovic, M , Ciric, J , Stojanovic, M . Optimizing the diagnostic criteria for standard (250 ug) and low dose (1 ug) adrenocorticotropin tests in the assessment of adrenal function
Journal Clinical Endocrinology Metabolism 84(9): 1999
5. Courtney, C H, McAllister, A S, Bell, P M. Low standard dose corticotrophin and insulin hypoglycemia testing in the assessment of hypothelamic pituitary adrenal function after pituitary surgery
Journal Clinical Endocrinology Metabolism 89(4): 2004
6. Agha, A , Tomlinson, J W, Clark, P M. The Long term predictive accuracy of the short synacthen (corticotrophin) stimulation test for assessment of the hypothalamic pituitary adrenal axis
Journal Clinical Endocrinology Metabolism 9(1): 2006
7. Lindholm, J , Kehlet, H . Re-evaluation of the clinical value of the 30 min ACTH test in assessing the hypothalamic-pituitary adrenocortical function
Clinical Endocrinology (Oxf) 26(1): 1987