M. Pura et al. (Lubochna and Prague) with the title : “The low dose (1 μg) Cosyntropin test (LDT) for Primary Adrenocortical Insufficiency: Defining the normal cortisol response and report on first patients with Addison Disease confirmed with LDT” (ECED 2010; 118: 151–157)

2010 ◽  
Vol 118 (06) ◽  
pp. 339-340 ◽  
Author(s):  
W. Oelkers
Keyword(s):  
Low Dose ◽  
Cortisol Response ◽  
Adrenocortical Insufficiency ◽  
Addison Disease

scholarly journals A high-sensitivity test in the assessment of adrenocortical insufficiency: 10 microg vs 250 microg cosyntropin dose assessment of adrenocortical insufficiency

1998 ◽  
Vol 159 (2) ◽  
pp. 275-280 ◽  
Author(s):  
JG Gonzalez-Gonzalez ◽  
NE De la Garza-Hernandez ◽  
LG Mancillas-Adame ◽  
J Montes-Villarreal ◽  
JZ Villarreal-Perez
Keyword(s):  
Healthy Subjects ◽  
Low Dose ◽  
Standard Dose ◽  
Addison’S Disease ◽  
High Sensitivity ◽  
Serum Cortisol ◽  
Dose Assessment ◽  
Addison's Disease ◽  
Acth Test ◽  
Adrenocortical Insufficiency

The short cosyntropin (synthetic ACTH) test is recognized as the best screening manoeuvre in the assessment of adrenocortical insufficiency. Recent data, however, suggest that i.v. administration of 250 microg cosyntropin could be a pharmacological rather than a physiological stimulus, losing sensitivity for detecting adrenocortical failure. Our objective was to compare 10 vs 250 microg cosyntropin in order to find differences in serum cortisol peaks in healthy individuals, the adrenocortical response in a variety of hypothalamic-pituitary-adrenal axis disorders and the highest sensitivity and specificity serum cortisol cut-off point values. The subjects were 83 healthy people and 37 patients, the latter having Addison's disease (11), pituitary adenomas (7), Sheehan's syndrome (9) and recent use of glucocorticoid therapy (10). Forty-six healthy subjects and all patients underwent low- and standard-dose cosyntropin testing. In addition, 37 controls underwent the low-dose test. On comparing low- and standard-dose cosyntropin testing in healthy subjects there were no statistical differences in baseline and peaks of serum cortisol. In the group of patients, 2 out of 11 cases of Addison's disease showed normal cortisol criterion values during the standard test but abnormal during the low-dose test. In our group of patients and controls, the statistical analysis displayed a better sensitivity of the low-dose vs standard-dose ACTH test at 30 and 60 min. In conclusion, these results suggest that the use of 10 microg rather than 250 microg cosyntropin i.v. in the assessment of suspicious adrenocortical dysfunction gives better results.

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

1997 ◽  
pp. 172-175 ◽  
Author(s):  
G Dickstein ◽  
D Spigel ◽  
E Arad ◽  
C Shechner
Keyword(s):  
Diurnal Variation ◽  
Cortisol Level ◽  
Low Dose ◽  
Cortisol Response ◽  
Acth Stimulation ◽  
Baseline Cortisol ◽  
Maximal Stimulation ◽  
Basal Cortisol ◽  
Basal Cortisol Level ◽  
Cortisol Responses

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 microgram, with which dose cortisol concentration increased to 607.2 +/- 182 nmol/l, compared with 612.7 +/- 140.8 nmol/l with the 250 micrograms test (P > 0.3). The use of smaller doses of ACTH (0.8 and 0.6 microgram) achieved significantly lower cortisol responses (312 +/- 179.4 and 323 +/- 157.3 nmol/l respectively; both P < 0.01 compared with the 1 microgram test). When a submaximal ACTH dose (0.6 microgram) 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 +/- 116 compared with 394.7 +/- 129.7 nmol/l) or 30 min (397.4 +/- 176.6 compared with 403 +/- 226.3 nmol/l; P > 0.3 for both times). These results show that 1.0 microgram 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.

Cortisol Response to Low-Dose ACTH Stimulation Test in Non-Stressed Pediatric Patients

2011 ◽  
pp. P2-741-P2-741
Author(s):  
Joran Sequeira ◽  
Richard A Noto ◽  
Qiuhu Shi ◽  
Mamatha Sandu ◽  
Figen Altunkaya ◽  
...  
Keyword(s):  
Low Dose ◽  
Pediatric Patients ◽  
Stimulation Test ◽  
Cortisol Response ◽  
Acth Stimulation Test ◽  
Acth Stimulation

Enhanced adrenal sensitivity to adrenocorticotrophic hormone (ACTH) is evidence of HPA axis hyperactivity in Alzheimer's disease

1996 ◽  
Vol 26 (1) ◽  
pp. 7-14 ◽  
Author(s):  
J. T. O'Brien ◽  
D. Ames ◽  
I. Schweitzer ◽  
M. Mastwyk ◽  
P. Colman
Keyword(s):  
Alzheimer’S Disease ◽  
Alzheimer's Disease ◽  
Hpa Axis ◽  
Low Dose ◽  
Age At Onset ◽  
Neuronal Loss ◽  
Inverse Correlation ◽  
Cognitive Test ◽  
Cortisol Response ◽  
Adrenocorticotrophic Hormone

SynopsisAdrenal sensitivity was assessed in 16 non-depressed patients with NINCDS/ADRDA Alzheimer's disease (AD) and 18 control subjects by measuring cortisol response to low dose (0·05 μg/kg i.v.) exogenous adrenocorticotrophic hormone (ACTH). Controlling for sex and medication, both peak cortisol level (peak–baseline) and area under cortisol response curve (AUC above baseline) were significantly greater in AD subjects. This shows that HPA axis hyperactivity, as demonstrated by enhanced adrenal sensitivity to ACTH, occurs in AD. Similar findings have been reported to occur in depression. Among AD subjects, AUC cortisol response correlated with current age (r= 0·70,P= 0·001) and age at onset of dementia (r= 0·73,P= 0·001) and an inverse correlation was seen between cortisol AUC and cognitive test (CAMCOG) score (r= −0·51,P= 0·044). Our findings suggest that HPA axis hyperactivity in AD is associated with advancing age and cognitive dysfunction. Such changes may be cause, or consequence, of neuronal loss.

scholarly journals Evaluation of adrenal function in patients with growth hormone deficiency and hypothalamic–pituitary disorders: comparison between insulin-induced hypoglycemia, low-dose ACTH, standard ACTH and CRH stimulation tests

2005 ◽  
Vol 152 (5) ◽  
pp. 735-741 ◽  
Author(s):  
M Maghnie ◽  
E Uga ◽  
F Temporini ◽  
N Di Iorgi ◽  
A Secco ◽  
...  
Keyword(s):  
Growth Hormone ◽  
Growth Hormone Deficiency ◽  
Adrenal Insufficiency ◽  
Low Dose ◽  
Clinical Symptoms ◽  
Adrenal Function ◽  
Hormone Deficiency ◽  
Cortisol Response ◽  
Normal Response ◽  
Morning Cortisol

Objectives: Patients with organic growth hormone deficiency (GHD) or with structural hypothalamic–pituitary abnormalities may have additional anterior pituitary hormone deficits, and are at risk of developing complete or partial corticotropin (ACTH) deficiency. Evaluation of the integrity of the hypothalamic–pituitary–adrenal axis (HPA) is essential in these patients because, although clinically asymptomatic, their HPA cannot appropriately react to stressful stimuli with potentially life-threatening consequences. Design and methods: In this study we evaluated the integrity of the HPA in 24 patients (age 4.2–31 years at the time of the study) with an established diagnosis of GHD and compared the reliability of the insulin tolerance test (ITT), short synacthen test (SST), low-dose SST (LDSST), and corticotropin releasing hormone (CRH) test in the diagnosis of adrenal insufficiency. Results: At a cortisol cut-off for a normal response of 550 nmol/l (20 μg/dl), the response to ITT was subnormal in 11 subjects, 6 with congenital and 5 with acquired GHD. Four patients had overt adrenal insufficiency, with morning cortisol concentrations ranging between 66.2–135.2 nmol/l (2.4–4.9 μg/dl) and typical clinical symptoms and laboratory findings. In all these patients, a subnormal cortisol response to ITT was confirmed by LDSST and by CRH tests. SST failed to identify one of the patients as adrenal insufficient. In the seven asymptomatic patients with a subnormal cortisol response to ITT, the diagnosis of adrenal insufficiency was confirmed in one by LDSST, in none by SST, and in five by CRH tests. The five patients with a normal cortisol response to ITT exhibited a normal response also after LDSST and SST. Only two of them had a normal response after a CRH test. In the seven patients with asymptomatic adrenal insufficiency mean morning cortisol concentration was significantly higher than in the patients with overt adrenal insufficiency. ITT was contraindicated in eight patients, and none of them had clinical symptoms of overt adrenal insufficiency. One of these patients had a subnormal cortisol response to LDSST, SST, and CRH, and three exhibited a subnormal response to CRH but normal responses to LDSST and to SST. Conclusion: We conclude that none of these tests can be considered completely reliable for establishing or excluding the presence of secondary or tertiary adrenal insufficiency. Consequently, clinical judgment remains one of the most important issues for deciding which patients need assessment or re–assessment of adrenal function.

scholarly journals P33 Serum total cortisol and plasma free cortisol response after low dose short synacthen test in stable cirrhosis

Gut ◽  
2011 ◽  
Vol 60 (Suppl 2) ◽  
pp. A15-A15
Author(s):  
G. Fede ◽  
L. Spadaro ◽  
T. Tomaselli ◽  
G. Privitera ◽  
R. Scicali ◽  
...  
Keyword(s):  
Low Dose ◽  
Cortisol Response ◽  
Total Cortisol ◽  
Free Cortisol ◽  
Synacthen Test ◽  
Short Synacthen Test

scholarly journals Glucocorticoid Functional Reserve in Full-Spectrum Intensity of Primary Hypothyroidism

2014 ◽  
Vol 2014 ◽  
pp. 1-8 ◽  
Author(s):  
René Rodríguez-Gutiérrez ◽  
Camilo González-Velázquez ◽  
Gerardo González-Saldívar ◽  
Jesús Zacarías Villarreal-Pérez ◽  
José Gerardo González-González
Keyword(s):  
Adrenal Insufficiency ◽  
Low Dose ◽  
Primary Hypothyroidism ◽  
Adrenocortical Function ◽  
Controlled Study ◽  
Control Group ◽  
Cortisol Response ◽  
Full Spectrum ◽  
Before And After ◽  
Prospective Longitudinal

Adrenal function might be impaired in patients with primary hypothyroidism. The objective was to evaluate adrenocortical function using the low-dose cosyntropin test in patients with primary hypothyroidism. Consequently a prospective, longitudinal, controlled study of sixty adult patients with primary hypothyroidism was carried out. Patientsnaïveto L-T4 treatment were compared with control participants. A low-dose cosyntropin test was done before and after L-T4 therapy. Thirty and sixty minutes after the low-dose cosyntropin, the mean cortisol values were lower in the cases group (612.6 ± 133.1 and 603.4 ± 153.7 nmol/L) when compared to the control group (677.0 ± 82.4 and 669.9 ± 83.7 nmol/L) (P=0.001and 0.003), respectively. After L-T4 therapy, this difference was lost. Four out of 60 cases (6.7%) taking a cortisol cutoff value of 500 mmol/L and 11 out of 60 (18.3%) having 550 mmol/L as the cutoff had adrenal insufficiency before L-T4 therapy. After L-T4 therapy, 50% and 81% of the cases had normal cortisol response. In conclusion, patients with different degrees of intensity of primary hypothyroidism had improved cortisol response after reaching euthyroidism. The incidence of adrenal insufficiency was 6.7–18.3% and more than 50% of the cases had a normal cortisol response after L-T4 therapy.

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