Utility of 30 and 60 minute cortisol samples after high-dose synthetic ACTH1–24 injection in the diagnosis of adrenal insufficiency
BACKGROUND: In clinical practise the high dose ACTH stimulation test (HDT) is frequently used in the assessment of adrenal insufficiency (AI). However, there is uncertainty regarding optimal time-points and number of blood samplings. The present study compared the utility of a single cortisol...
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| Format: | Article |
| Language: | English |
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SMW supporting association (Trägerverein Swiss Medical Weekly SMW)
2014-07-01
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| Series: | Swiss Medical Weekly |
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| Online Access: | https://www.smw.ch/index.php/smw/article/view/1883 |
| _version_ | 1826995908002185216 |
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| author | Thomas Zueger Marlen Jordi Markus Laimer Christoph Stettler |
| author_facet | Thomas Zueger Marlen Jordi Markus Laimer Christoph Stettler |
| author_sort | Thomas Zueger |
| collection | DOAJ |
| description |
BACKGROUND: In clinical practise the high dose ACTH stimulation test (HDT) is frequently used in the assessment of adrenal insufficiency (AI). However, there is uncertainty regarding optimal time-points and number of blood samplings. The present study compared the utility of a single cortisol value taken either 30 or 60 minutes after ACTH stimulation with the traditional interpretation of the HDT.
METHODS: Retrospective analysis of 73 HDT performed at a single tertiary endocrine centre. Serum cortisol was measured at baseline, 30 and 60 minutes after intravenous administration of 250 µg synthetic ACTH1–24. Adrenal insufficiency (AI) was defined as a stimulated cortisol level <550 nmol/l.
RESULTS: There were twenty patients (27.4%) who showed an insufficient rise in serum cortisol using traditional HDT criteria and were diagnosed to suffer from AI. There were ten individuals who showed insufficient cortisol values after 30 minutes, rising to sufficient levels at 60 minutes. All patients revealing an insufficient cortisol response result after 60 minutes also had an insufficient result after 30 minutes. The cortisol value taken after 30 minutes did not add incremental diagnostic value in any of the cases under investigation compared with the 60 minutes’ sample.
CONCLUSIONS: Based on the findings of the present analysis the utility of a cortisol measurement 30 minutes after high dose ACTH injection was low and did not add incremental diagnostic value to a single measurement after 60 minutes.
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| format | Article |
| id | doaj.art-995727e080204f14bbf711e1a1f6c18a |
| institution | Directory Open Access Journal |
| issn | 1424-3997 |
| language | English |
| last_indexed | 2025-02-18T09:40:03Z |
| publishDate | 2014-07-01 |
| publisher | SMW supporting association (Trägerverein Swiss Medical Weekly SMW) |
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| series | Swiss Medical Weekly |
| spelling | doaj.art-995727e080204f14bbf711e1a1f6c18a2024-11-02T17:26:20ZengSMW supporting association (Trägerverein Swiss Medical Weekly SMW)Swiss Medical Weekly1424-39972014-07-01144293010.4414/smw.2014.13987Utility of 30 and 60 minute cortisol samples after high-dose synthetic ACTH1–24 injection in the diagnosis of adrenal insufficiencyThomas ZuegerMarlen JordiMarkus LaimerChristoph Stettler BACKGROUND: In clinical practise the high dose ACTH stimulation test (HDT) is frequently used in the assessment of adrenal insufficiency (AI). However, there is uncertainty regarding optimal time-points and number of blood samplings. The present study compared the utility of a single cortisol value taken either 30 or 60 minutes after ACTH stimulation with the traditional interpretation of the HDT. METHODS: Retrospective analysis of 73 HDT performed at a single tertiary endocrine centre. Serum cortisol was measured at baseline, 30 and 60 minutes after intravenous administration of 250 µg synthetic ACTH1–24. Adrenal insufficiency (AI) was defined as a stimulated cortisol level <550 nmol/l. RESULTS: There were twenty patients (27.4%) who showed an insufficient rise in serum cortisol using traditional HDT criteria and were diagnosed to suffer from AI. There were ten individuals who showed insufficient cortisol values after 30 minutes, rising to sufficient levels at 60 minutes. All patients revealing an insufficient cortisol response result after 60 minutes also had an insufficient result after 30 minutes. The cortisol value taken after 30 minutes did not add incremental diagnostic value in any of the cases under investigation compared with the 60 minutes’ sample. CONCLUSIONS: Based on the findings of the present analysis the utility of a cortisol measurement 30 minutes after high dose ACTH injection was low and did not add incremental diagnostic value to a single measurement after 60 minutes. https://www.smw.ch/index.php/smw/article/view/1883ACTH stimulation teststimulated serum cortisoladrenal insufficiency |
| spellingShingle | Thomas Zueger Marlen Jordi Markus Laimer Christoph Stettler Utility of 30 and 60 minute cortisol samples after high-dose synthetic ACTH1–24 injection in the diagnosis of adrenal insufficiency Swiss Medical Weekly ACTH stimulation test stimulated serum cortisol adrenal insufficiency |
| title | Utility of 30 and 60 minute cortisol samples after high-dose synthetic ACTH1–24 injection in the diagnosis of adrenal insufficiency |
| title_full | Utility of 30 and 60 minute cortisol samples after high-dose synthetic ACTH1–24 injection in the diagnosis of adrenal insufficiency |
| title_fullStr | Utility of 30 and 60 minute cortisol samples after high-dose synthetic ACTH1–24 injection in the diagnosis of adrenal insufficiency |
| title_full_unstemmed | Utility of 30 and 60 minute cortisol samples after high-dose synthetic ACTH1–24 injection in the diagnosis of adrenal insufficiency |
| title_short | Utility of 30 and 60 minute cortisol samples after high-dose synthetic ACTH1–24 injection in the diagnosis of adrenal insufficiency |
| title_sort | utility of 30 and 60 minute cortisol samples after high dose synthetic acth1 24 injection in the diagnosis of adrenal insufficiency |
| topic | ACTH stimulation test stimulated serum cortisol adrenal insufficiency |
| url | https://www.smw.ch/index.php/smw/article/view/1883 |
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