Short ACTH test in assessing hypothalamic-pituitary-adrenocortical function.

Kehlet, Henrik; Blichert-Toft, M; Lindholm, Jörgen; Rasmussen, Per

doi:10.1136/bmj.1.6004.249

Cited by 73 publications

(27 citation statements)

References 5 publications

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“…We used the definition of a stimulated cortisol value of 18 µg/dL or above to define adequate cortisol response based on general acceptance and the original study done on healthy, nonstressed adults that was compared to the gold standard of an insulin tolerance test and also correlated to adrenal response to the stress of surgery [9, 14]. However, the criterion of a change from basal to peak cortisol of +9 µg/dL is also sometimes employed, but this criterion was not originally correlated with response to surgical stress.…”

Section: Discussionmentioning

confidence: 99%

Correlation between Cosyntropin Stimulation Study and Disease Severity in Children with Fluid- and Catecholamine-Refractory Shock in the Pediatric and Cardiovascular Intensive Care Unit

et al. 2017

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Background: The cosyntropin stimulation study (CSS) measures the patient’s ability to adequately mount a cortisol response. Clinically, CSS results may not be used to guide hydrocortisone use. The objective of this study was to examine how the CSS results are associated with clinical parameters, mortality/disease severity, and use of glucocorticoids in pediatric patients with catecholamine- and fluid-resistant shock. Methods: This was a retrospective cohort study of patients who had a CSS during 2009–2014 in the intensive care unit at a children’s hospital. Data collected included clinical variables, mortality, biochemical studies, and glucocorticoid use. PRISM III scores were used to determine the association between CSS results and disease severity. Adequate response to cosyntropin was defined as peak cortisol of 18 µg/dL or higher. Results: Of the 76 patients that underwent CSS, 68 (89%) had an adequate response to cosyntropin. There was a positive correlation between peak cortisol and PRISM III score (r = 0.45, r² = 0.2). Glucocorticoid was administered in 52/76 (68%) despite several patients with normal CSS results. Conclusions: Sicker patients were more likely to have an adequate response to CSS. Clinically, glucocorticoid supplementation was not based on CSS results. Further prospective studies are needed to elucidate if CSS is a valuable clinical tool.

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Section: Discussionmentioning

confidence: 99%

Correlation between Cosyntropin Stimulation Study and Disease Severity in Children with Fluid- and Catecholamine-Refractory Shock in the Pediatric and Cardiovascular Intensive Care Unit

et al. 2017

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“…It has been widely accepted, leaving out the case of recent hypothalamic and/or pituitary dysfunction, that a normal cortisol response to the harmless standard adrenocorticotrophin (ACTH(1-24)) (tetracosactrin, 250 mg) test faithfully predicts the integrity of the HPA axis (1,2). However, many discrepancies between results obtained with the ITT and the standard ACTH(1-24) test have already been reported, some of them leading to misdiagnosis of central hypoadrenalism (3)(4)(5)(6).…”

Section: Introductionmentioning

confidence: 99%

On the meaning of low-dose ACTH(1-24) tests to assess functionality of the hypothalamic-pituitary-adrenal axis

Darmon

Dadoun²,

Frachebois³

et al. 1999

European Journal of Endocrinology

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To analyse further the ACTH(1-24) low-dose test, which is of clinical interest, we have examined the dose-response relationship between plasma ACTH(1-24) and cortisol concentrations after i.v. administration of increasing doses (1, 5 or 250 mg) of ACTH(1-24) as a bolus. In addition, we have measured plasma ACTH(1-39) and cortisol levels after an insulin tolerance test (ITT). Although there was a dose-response relationship between plasma ACTH(1-24) immunoreactivity and the dose injected, cortisol peaks were comparable, but lower than those reached after an ITT. Under these experimental conditions, an increase in plasma ACTH as low as 13 pmol/l (i.e. the increase obtained with the 1 mg dose) induced a near maximal cortisol response. Following injection of 1 mg ACTH(1-24), peak ACTH values were short lasting, similar to physiological daily bursts. After injection of 5 mg ACTH(1-24), plasma ACTH concentrations were higher than those reached during an ITT, but clearly shorter lasting. Injection of 250 mg ACTH(1-24) induced strikingly supraphysiological levels of plasma ACTH. We conclude that neither regular nor low-dose ACTH tests can fully reproduce the ITT. Our observations strongly suggest that the low-dose ACTH(1-24) test (1 mg) can be useful to estimate the adrenal sensitivity under basal, physiological conditions.

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“…The A C T H test for assessing the adrenal responsiveness was carried out in the morning between 0900 and 1100 hours with the consent of all volunteers and patients. The test was performed according to the m e t h o d o f Khelet et al [6]. Blood was drawn 15 rain and immediately before intravenous injection o f 0.25 mg A C T H (Synacthen) as well as 30 and 60 min after the injection.…”

Section: Methodsmentioning

confidence: 99%

Adrenocortical responsiveness after discontinuous corticosteroid therapy

Beris¹,

Bürger²,

Favre³

et al. 1986

Klin Wochenschr

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Plasma cortisol levels and the response of the adrenal gland to 0.25 mg ACTH administration were measured in 12 patients receiving 15 mg or more of a short-acting steroid (fluocortolone or prednisone) on three out of four days, in 10 patients on daily steroid treatment (15 mg prednisone or more per day), and in 9 normal subjects. The basal plasma cortisol level of the first group was between that of patients on daily prednisone treatment and that of normal subjects. The adrenal function in patients on the three out of four day treatment schedule appeared to be slightly diminished, yet still within the accepted limits for adrenals capable of responding adequately to stress. The adrenal function proved insufficient in all patients on daily steroids. The three out of four day steroid regimen thus offers a solution with many advantages over continuous steroid treatment for patients refractory to the alternate-day schedule.

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Short ACTH test in assessing hypothalamic-pituitary-adrenocortical function.

Cited by 73 publications

References 5 publications

Correlation between Cosyntropin Stimulation Study and Disease Severity in Children with Fluid- and Catecholamine-Refractory Shock in the Pediatric and Cardiovascular Intensive Care Unit

Correlation between Cosyntropin Stimulation Study and Disease Severity in Children with Fluid- and Catecholamine-Refractory Shock in the Pediatric and Cardiovascular Intensive Care Unit

On the meaning of low-dose ACTH(1-24) tests to assess functionality of the hypothalamic-pituitary-adrenal axis

Adrenocortical responsiveness after discontinuous corticosteroid therapy

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