Dehydroepiandrosterone, 17α-hydroxyprogesterone and aldosterone responses to the low-dose (1 μg) ACTH test in subjects with preclinical adrenal autoimmunity

被引:19
作者
Laureti, S
Candeloro, P
Aglietti, MC
Giordano, R
Arvat, E
Ghigo, E
Santeusanio, F
Falorni, A
机构
[1] Univ Perugia, Dept Internal Med & Endocrine & Metab Sci, I-06100 Perugia, Italy
[2] Univ Turin, Dept Internal Med, Div Endocrinol, Turin, Italy
关键词
D O I
10.1046/j.1365-2265.2002.01651.x
中图分类号
R5 [内科学];
学科分类号
1002 ; 100201 ;
摘要
OBJECTIVE The appearance of 21-hydroxylase autoantibodies (21OHAbs) identifies subjects with preclinical adrenal insufficiency. In 21OHAb-positive subjects, the adrenocortical function is best evaluated by peak cortisol (F) levels after the low-dose (1 mug) ACTH stimulation test (LDT). No information is currently available on the correlation between F and other adrenocortical hormone responses to the LDT in subjects with an ongoing autoimmune adrenal process. In this study, we tested the hypothesis that the dehydroepiandrosterone (DHEA), 17alpha-hydroxyprogesterone (17OHP) and aldosterone (A) responses to the LDT are consensual to that of F during the preclinical phase of autoimmune adrenal insufficiency. DESIGN AND PATIENTS We studied 12 subjects positive for 21OHAb, in the absence of clinical signs of adrenal insufficiency. On the basis of peak F levels after the LDT, and according to the lower level of normal observed in 15 healthy volunteers (510.4 nmol/l), patients were subdivided into two groups: group A, n = 6 subjects with normal F response; and group B, n = 6 subjects with impaired F response. Results were expressed as absolute delta increase (Delta) between peak and basal levels. RESULTS DeltaF was significantly higher in group A (314.5 +/-115.8 nmol/l) than in group B (151.7 +/- 88.2 nmol/l) (P = 0.041). DeltaDHEA and Delta17OHP were also significantly higher in group A (17.0 +/- 13.5 nmol/l and 6.1 +/- 4.4 nmol/l, respectively) than in group B (0.69 +/- 2.25 nmol/l and 1.9 +/- 1.7 nmol/l, respectively) (P = 0.002 and P = 0.041). The difference in DeltaA between the two groups did not reach statistical significance (group A 321.8 +/- 272.0 pmol/l vs. group B 157.0 +/- 154.0 pmol/l). DeltaDHEA, Delta17OHP and DeltaA tended to correlate positively with DeltaF (P = 0.039, P = 0.039 and P = 0.044, respectively), but the correlations did not reach significance after correction of the P-value. CONCLUSIONS Our study demonstrates a high concordance between F and DHEA, 17OHP and A responses to the LDT in subjects with preclinical adrenal autoimmunity, thus strengthening the concept that the LDT is an accurate test to identify early adrenal dysfunction.
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页码:677 / 683
页数:7
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共 35 条
[1]   Comparison of the low dose short synacthen test (1 μg), the conventional dose short synacthen test (250 μg), and the insulin tolerance test for assessment of the hypothalamo-pituitary-adrenal axis in patients with pituitary disease [J].
Abdu, TAM ;
Elhadd, TA ;
Neary, R ;
Clayton, RN .
JOURNAL OF CLINICAL ENDOCRINOLOGY & METABOLISM, 1999, 84 (03) :838-843
[2]   The role of the low dose ACTH test in the evaluation of central hypoadrenalism [J].
Ambrosi, B ;
Barbetta, L .
JOURNAL OF ENDOCRINOLOGICAL INVESTIGATION, 1999, 22 (06) :492-495
[3]   Stimulatory effect of adrenocorticotropin on cortisol, aldosterone, and dehydroepiandrosterone secretion in normal humans: Dose-response study [J].
Arvat, E ;
Di Vito, L ;
Lanfranco, F ;
Maccario, M ;
Baffoni, C ;
Rossetto, R ;
Aimaretti, G ;
Camanni, F ;
Ghigo, E .
JOURNAL OF CLINICAL ENDOCRINOLOGY & METABOLISM, 2000, 85 (09) :3141-3146
[4]   Adrenal cortex and steroid 21-hydroxylase autoantibodies in adult patients with organ-specific autoimmune diseases: Markers of low progression to clinical Addison's disease .1. [J].
Betterle, C ;
Volpato, M ;
Smith, BR ;
Furmaniak, J ;
Chen, S ;
Greggio, NA ;
Sanzari, M ;
Tedesco, F ;
Pedini, B ;
Boscaro, M ;
Presotto, F .
JOURNAL OF CLINICAL ENDOCRINOLOGY & METABOLISM, 1997, 82 (03) :932-938
[5]   Hormonal responses during various phases of autoimmune adrenal failure: No evidence for 21-hydroxylase enzyme activity inhibition in vivo [J].
Boscaro, M ;
Betterle, C ;
Volpato, M ;
Fallo, F ;
Furmaniak, J ;
Smith, BR ;
Sonino, N .
JOURNAL OF CLINICAL ENDOCRINOLOGY & METABOLISM, 1996, 81 (08) :2801-2804
[6]   LOW-DOSE ADRENOCORTICOTROPIN TEST REVEALS IMPAIRED ADRENAL-FUNCTION IN PATIENTS TAKING INHALED CORTICOSTEROIDS [J].
BROIDE, J ;
SOFERMAN, R ;
KIVITY, S ;
GOLANDER, A ;
DICKSTEIN, G ;
SPIRER, Z ;
WEISMAN, Y .
JOURNAL OF CLINICAL ENDOCRINOLOGY & METABOLISM, 1995, 80 (04) :1243-1246
[7]   Comparison of one week 0900 h serum cortisol, low and standard dose Synacthen tests with a 4 to 6 week insulin hypoglycaemia test after pituitary surgery in assessing HPA axis [J].
Courtney, CH ;
McAllister, AS ;
McCance, DR ;
Bell, PM ;
Hadden, DR ;
Leslie, H ;
Sheridan, B ;
Atkinson, AB .
CLINICAL ENDOCRINOLOGY, 2000, 53 (04) :431-436
[8]   RESPONSES OF PLASMA ADRENOCORTICAL STEROIDS TO LOW-DOSE ACTH IN NORMAL SUBJECTS [J].
DAIDOH, H ;
MORITA, H ;
MUNE, T ;
MURAYAMA, M ;
HANAFUSA, J ;
NI, H ;
SHIBATA, H ;
YASUDA, K .
CLINICAL ENDOCRINOLOGY, 1995, 43 (03) :311-315
[9]   REMISSION OF SUBCLINICAL ADRENOCORTICAL FAILURE IN SUBJECTS WITH ADRENAL AUTOANTIBODIES [J].
DEBELLIS, A ;
BIZZARRO, A ;
ROSSI, R ;
PAGLIONICO, VA ;
CRISCUOLO, T ;
LOMBARDI, G ;
BELLASTELLA, A .
JOURNAL OF CLINICAL ENDOCRINOLOGY & METABOLISM, 1993, 76 (04) :1002-1007
[10]   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 [J].
Dickstein, G ;
Spigel, D ;
Arad, E ;
Shechner, C .
EUROPEAN JOURNAL OF ENDOCRINOLOGY, 1997, 137 (02) :172-175