Comparison of 1-μg and 250-μg corticotropin stimulation tests for the evaluation of adrenal function in patients with acquired immunodeficiency syndrome

Smolyar, D.; Tirado-Bernardini, R.; Landman, Roland; Lesser, Martin; Young, Iven S.; Poretsky, Leonid

doi:10.1053/meta.2003.50099

Cited by 11 publications

(11 citation statements)

References 31 publications

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“…All of these individuals had a suboptimal response to the low-dose corticotropin stimulation test and a normal response to the high-dose corticotropin stimulation test. Discordant cortisol responses to low-and high-dose corticotropin stimulation in HIV-positive patients have been previously reported [64]. The causes of this discrepancy remain unclear, but may include technical difficulties in administering effectively extremely small (1 lg) amount of corticotropin and changes in sensitivity to corticotropin in HIV-infected individuals [46,64].…”

Section: Discussionmentioning

confidence: 94%

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Endocrine effects of oral dehydroepiandrosterone in men with HIV infection: a prospective, randomized, double-blind, placebo-controlled trial

et al. 2006

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Section: Discussionmentioning

confidence: 94%

“…Prevalence of adrenal insufficiency in individuals with HIV infection ranges between 0% and 25% [39,46,64]. Its pathogenesis remains unclear, but potential causes include adrenal gland and hypothalamic/pituitary infection by HIV or opportunistic organisms [47] and possible resistance to the effects of cortisol [48].…”

Section: Discussionmentioning

confidence: 99%

Endocrine effects of oral dehydroepiandrosterone in men with HIV infection: a prospective, randomized, double-blind, placebo-controlled trial

et al. 2006

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“…28 Non-tuberculous causes of primary adrenal infection including cryptococcus, histoplasma, cytomegalovirus, toxoplasma and pneumocystis are quite rare and tend to occur in immunosuppressed patients. 29 …”

Section: Infectionsmentioning

confidence: 99%

The diagnosis and investigation of adrenal insufficiency in adults

2009

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There is considerable variation in the methods used to diagnose and investigate adrenal insufficiency in clinical practice. These include a range of adrenocorticotropin (ACTH) stimulation and other dynamic testing protocols, serum cortisol cut-off values for diagnosis and tests used for differential diagnosis. With the introduction of modern cortisol and ACTH assays, the interpretation of tests used for diagnosis and differential diagnosis has become more complex and requires local validation. This review examines the basis of normal hypothalamic-pituitary -adrenal axis function and adrenal insufficiency states based upon an evidence base accumulated over the past four decades. The role of the laboratory in the differential diagnosis and interpretation based upon assay methodology is discussed. The accurate identification of patients who may benefit from corticosteroid replacement in special settings such as critical illness is challenging and will be explored.

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“…Standard cosyntropin test is performed by administering 250 µg of cosyntropin intravenously and then measuring serum cortisol levels 30 and 60 minutes later [6,[10][11][12]. With a normal result for the test, the serum cortisol level after cosyntropin stimulation is greater than at least 18.0 µg/dl [6, 7, 10-13].…”

Section: Discussionmentioning

confidence: 99%

“…Taken together, the cortisol response to cosyntropin is likely to depend on the degree of adrenal failure, and some of the adrenocortical cells in our case might be intact in spite of primary adrenal insufficiency. Subclinical adrenal insufficiency states are found in a longitudinal follow-up of cases with HIV disease, adrenal autoantibodies, or a family history of adrenoleukodystrophy or adrenomyeloneuropathy [10,[16][17][18][19]. The general concept of subclinical adrenal insufficiency is that the patients with HIV disease or adrenal autoantibodies have no endocrine indicators.…”

Section: Discussionmentioning

confidence: 99%

A Case of Addison's Disease Confirmed with Low Dose Cosyntropin Stimulation Test

et al. 2007

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Abstract. An eighty-year-old man who had complained of skin pigmentation and weight loss was referred to our hospital. Upon physical examination, marked hyperpigmentation was found on the whole body including oral mucosa, tongue and fingernails. Endocrinological findings showed increased ACTH (126 pg/ml) and normal serum cortisol (15.4 µg/dl). First, we used a 250 µg cosyntropin stimulation test which is valid to diagnose Addison's disease, resulting in an adequate cortisol response. Second, we performed 1 µg cosyntropin stimulation test, and the cortisol response was blunted. Since the diagnosis of Addison's disease was fairly certain, he was treated with hydrocortisone 15 mg/day, and improvement of his skin pigmentation and an increase in body weight were observed. To our knowledge, this is the first report that 1 µg cosyntropin stimulation test was helpful to make diagnosis as having Addison's disease rather than the 250 µg cosyntropin stimulation test, although it is established that the 1 µg cosyntropin stimulation test is useful in secondary or relative adrenal insufficiency.

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Comparison of 1-μg and 250-μg corticotropin stimulation tests for the evaluation of adrenal function in patients with acquired immunodeficiency syndrome

Cited by 11 publications

References 31 publications

Endocrine effects of oral dehydroepiandrosterone in men with HIV infection: a prospective, randomized, double-blind, placebo-controlled trial

Endocrine effects of oral dehydroepiandrosterone in men with HIV infection: a prospective, randomized, double-blind, placebo-controlled trial

The diagnosis and investigation of adrenal insufficiency in adults

A Case of Addison's Disease Confirmed with Low Dose Cosyntropin Stimulation Test

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