The low dose (1 μg) ACTH stimulation test for assessment of the hypothalamo-pituitary-adrenal axis

被引:29
作者
Beishuizen, A
van Lijf, JH
Lekkerkerker, JFF
Vermes, I
机构
[1] Med Spectrum Twente, Dept Clin Chem, NL-7500 KA Enschede, Netherlands
[2] Med Spectrum Twente, Dept Internal Med, NL-7500 KA Enschede, Netherlands
关键词
adrenal insufficiency; ACTH stimulation test; hypothalamo-pituitary-adrenal axis; insulin tolerance test;
D O I
10.1016/S0300-2977(99)00111-4
中图分类号
R5 [内科学];
学科分类号
1002 ; 100201 ;
摘要
Traditional testing of the hypothalamo-pituitary-adrenal axis function has relied essentially upon the insulin tolerance test or the metyrapone challenge: both tests are not only uncomfortable, but carry also real dangers. The standard ACTH stimulation test uses an extremely hyperphysiological amount (250 mu g) of ACTH to evaluate a physiologic response, which may result in false normal responses. The proposed low dose (1 mu g) ACTH test is more physiological and more sensitive, especially in cases of mild adrenal insufficiency and allows also to assess pituitary-adrenal suppression after long-term treatment with glucocorticoids. According to the rules of evidence-based medicine, the low dose ACTH test should replace the conventional 250 mu g test when evaluating for central adrenal insufficiency. (C) 2000 Elsevier Science B.V. All rights reserved.
引用
收藏
页码:91 / 99
页数:9
相关论文
共 58 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 one microgram adrenocorticotropin test in the assessment of hypothalamic-pituitary-adrenal function [J].
Ambrosi, B ;
Barbetta, L ;
Re, T ;
Passini, E ;
Faglia, G .
EUROPEAN JOURNAL OF ENDOCRINOLOGY, 1998, 139 (06) :575-579
[3]   A comparison between short ACTH and insulin stress tests for assessing hypothalamo-pituitary-adrenal function [J].
Ammari, F ;
Issa, BG ;
Millward, E ;
Scanlon, MF .
CLINICAL ENDOCRINOLOGY, 1996, 44 (04) :473-476
[4]   Relative eosinophilla and functional adrenal insufficiency in critically ill patients [J].
Beishuizen, A ;
Vermes, I ;
Hylkema, BS ;
Haanen, C .
LANCET, 1999, 353 (9165) :1675-1676
[5]   DISCORDANT CORTISOL RESPONSE TO EXOGENOUS ACTH AND INSULIN-INDUCED HYPOGLYCEMIA IN PATIENTS WITH PITUITARY DISEASE [J].
BORST, GC ;
MICHENFELDER, HJ ;
OBRIAN, JT .
NEW ENGLAND JOURNAL OF MEDICINE, 1982, 306 (24) :1462-1464
[6]   EARLY ADRENAL HYPOFUNCTION IN PATIENTS WITH ORGAN-SPECIFIC AUTOANTIBODIES AND NO CLINICAL ADRENAL INSUFFICIENCY [J].
BOSCARO, M ;
BETTERLE, C ;
SONINO, N ;
VOLPATO, M ;
PAOLETTA, A ;
FALLO, F .
JOURNAL OF CLINICAL ENDOCRINOLOGY & METABOLISM, 1994, 79 (02) :452-455
[7]   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
[9]   THE USE OF LOW-DOSES OF ACTH IN THE INVESTIGATION OF ADRENAL-FUNCTION IN MAN [J].
CROWLEY, S ;
HINDMARSH, PC ;
HOLOWNIA, P ;
HONOUR, JW ;
BROOK, CGD .
JOURNAL OF ENDOCRINOLOGY, 1991, 130 (03) :475-479
[10]   REPRODUCIBILITY OF THE CORTISOL RESPONSE TO STIMULATION WITH A LOW-DOSE OF ACTH(1-24) - THE EFFECT OF BASAL CORTISOL-LEVELS AND COMPARISON OF LOW-DOSE WITH HIGH-DOSE SECRETORY DYNAMICS [J].
CROWLEY, S ;
HINDMARSH, PC ;
HONOUR, JW ;
BROOK, CGD .
JOURNAL OF ENDOCRINOLOGY, 1993, 136 (01) :167-172