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ACTH stimulation testing in Filipinos: Review of test results at a tertiary referral endocrine center.


Marjorie A. Ramos,
Jocelyn Jayme-Wohldorf

Related Institution

St. Luke's Medical Center, Quezon City, Metro Manila, Philippines

Publication Information

Publication Type
Sub Type
Journal Article, Original
Philippine Journal of Internal Medicine
Date of Publication
May-June 2007
145 - 150


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)


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