Responses of plasma adrenocortical steroids to low dose ACTH in normal subjects

Daidoh, Hisashi; Morita, Hiroyuki; Mune, Tomoatsu; Murayama, Masanori; Hanafusa, Junko; Ni, Huiping; Shibata, Haruki; Yasuda, Keigo

doi:10.1111/j.1365-2265.1995.tb02037.x

Cited by 110 publications

(97 citation statements)

References 21 publications

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“…However, this test is labor intensive and contraindicated in some patients. The low-dose (1 mg) ACTH test has recently been introduced and proved to be sensitive in revealing partial adrenal insufficiency by providing physiological adrenocortical stimulation (5,6). The results of the low-dose (1 mg) ACTH test correlate closely with those of the reference test for the function of the HPA axis (7), and are superior to the standard (250 mg) ACTH test (8).…”

Section: Introductionmentioning

confidence: 69%

Adrenal function during coronary artery bypass grafting

Henzen

Kobza²,

Schwaller-Protzmann³

et al. 2003

European Journal of Endocrinology

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Objective: To assess adrenal function in patients undergoing coronary artery bypass grafting (CABG) by means of the low-dose (1 mg) ACTH test, and to correlate the adrenal function with clinical outcome. Methods: During a 5-month period we prospectively included 45 patients undergoing elective CABG with cardiopulmonary bypass and without symptoms of endocrine disease. Low-dose (1 mg) ACTH tests were performed on the day before surgery (day 21), immediately after the operation (day 0), on the two subsequent days in the intensive care unit (day 1 and day 2), and on the day of discharge from the hospital. A number of clinical, hemodynamic and laboratory parameters were monitored throughout. Results: On day 2 1, 75% of the study patients had normal stimulated plasma cortisol concentrations. Eleven patients (25%) had an impaired adrenal response to 1 mg ACTH. The stimulated plasma cortisol concentrations in patients who had an inadequate adrenal response on day 2 1 remained significantly reduced on day 1 (756^205 vs 949^259 nmol/l, P ¼ 0.03) (mean^S.D.), day 2 (644 (580 -793) vs 885 (713-1087), P ¼ 0.03) (median (interquartile range)), and on the day of discharge (698^201 vs 854^186, P ¼ 0.05). In patients with a normal adrenal response in the preoperative setting peak cortisol concentrations were reached on day 1, in patients with a blunted adrenal response they were reached on day 2. There were significant correlations between the stimulated plasma cortisol concentrations and the blood loss (r ¼ 2 0.50, P ¼ 0.002) and volume balance (r ¼ 0.41, P ¼ 0.015). Conclusions: Occult (partial) adrenal insufficiency is common in patients undergoing CABG who are otherwise asymptomatic as regards endocrine disease. The adrenal function in these patients differs both in the magnitude of cortisol response to ACTH and in the time course, with significantly delayed peak cortisol concentrations. Adequate regulation of volume balance and the amount of blood loss seem to correlate with adequacy of adrenal function.

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Section: Introductionmentioning

confidence: 69%

Adrenal function during coronary artery bypass grafting

Henzen

Kobza²,

Schwaller-Protzmann³

et al. 2003

European Journal of Endocrinology

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“…; s.c. injection with 2.5 mg (10) or even 4.0 mg (11) ACTH will cause no increase in plasma cortisol. Daidoh et al (12) found that 0.5 mg ACTH i.v. was the smallest dose that caused maximal stimulation of cortisol under normal conditions, starting with normal basal cortisol levels of about 200 nmol/l.…”

Section: Discussionmentioning

confidence: 99%

One microgram is the lowest ACTH dose to cause a maximal cortisol response. There is no diurnal variation of cortisol response to submaximal ACTH stimulation

Dickstein

Spigel

Arad

et al. 1997

European Journal of Endocrinology

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There are many suggestions in the literature that the adrenal gland is more sensitive to ACTH in the evening than in the morning. However, all these studies in humans were conducted when the basal cortisol level was not suppressed, and were based on the observation that, after stimulation, the increases in cortisol differed, though the peak values were the same. To examine this, we established the lowest ACTH dose that caused a maximal cortisol stimulation even when the basal cortisol was suppressed, and used a smaller dose of ACTH for morning and evening stimulation. The lowest ACTH dose to achieve maximal stimulation was found to be 1.0 mg, with which dose cortisol concentration increased to 607.2 Ϯ 182 nmol/l, compared with 612.7 Ϯ 140.8 nmol/l with the 250 mg test (P > 0.3). The use of smaller doses of ACTH (0.8 and 0.6 mg) achieved significantly lower cortisol responses ( 312 Ϯ 179.4 and 323 Ϯ 157.3 nmol/l respectively; both P < 0.01 compared with the 1 mg test). When a submaximal ACTH dose (0.6 mg) was used to stimulate the adrenal at 0800 and 1600 h, after pretreatment with dexamethasone, no difference in response was noted at either 15 min (372.6 Ϯ 116 compared with 394.7 Ϯ 129.7 nmol/l) or 30 min (397.4 Ϯ 176.6 compared with 403 Ϯ 226.3 nmol/l; P > 0.3 for both times). These results show that 1.0 mg ACTH, used latterly as a low-dose test, is very potent in stimulating the adrenal, even when baseline cortisol is suppressed; smaller doses cause reduction of this potency. Our data show that there is probably no diurnal variation in the response of the adrenal to ACTH, if one eliminates the influence of the basal cortisol level and uses physiologic rather than superphysiologic stimuli.

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“…Preventing sodium accumulation by ACTH infusion into sodium-restricted subjects results in prolonged stimulation of aldosterone production (Tucci et al 1967). A sustained increase in THAldo excretion rate over four days of ACTH infusion has been reported (Pratt et al 1976), while more than one study has reported that levels of plasma aldosterone are more sensitive to ACTH stimulation than either cortisol or DHEA (Kem et al 1975;Daidoh et al 1995). Biglieri found aldosterone to be within the normal range -but not increased -in Cushing's syndrome (Biglieri et al 1963).…”

Section: Association Of 11-hydroxylation Efficiency With Hypertensionmentioning

confidence: 99%