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
[21]   A high-sensitivity test in the assessment of adrenocortical insufficiency:: 10 μg vs 250 μg cosyntropin dose assessment of adrenocortical insufficiency [J].
González-González, JG ;
De la Garza-Hernández, NE ;
Mancillas-Adame, LG ;
Montes-Villarreal, J ;
Villarreal-Pérez, JZ .
JOURNAL OF ENDOCRINOLOGY, 1998, 159 (02) :275-280
[22]   NATURAL HISTORY OF PITUITARY-ADRENAL RECOVERY FOLLOWING LONG-TERM SUPPRESSION WITH CORTICOSTEROIDS [J].
GRABER, AL ;
NEY, RL ;
NICHOLSON, WE ;
ISLAND, DP ;
LIDDLE, GW .
JOURNAL OF CLINICAL ENDOCRINOLOGY & METABOLISM, 1965, 25 (01) :11-+
[23]   PHYSIOLOGICAL DOSING OF EXOGENOUS ACTH [J].
GRAYBEAL, ML ;
FANG, VS .
ACTA ENDOCRINOLOGICA, 1985, 108 (03) :401-406
[24]   RECOVERY OF HYPOTHALAMO-PITUITARY ADRENAL-FUNCTION IN ASTHMATICS WHOSE ORAL STEROIDS HAVE BEEN STOPPED OR REDUCED [J].
HARRISON, BDW ;
REES, LH ;
CAYTON, RM ;
NABARRO, JDN .
CLINICAL ENDOCRINOLOGY, 1982, 17 (02) :109-118
[25]  
HERMUS ARM, 1981, NED TIJDSCHR GENEESK, V142, P944
[26]   The short Synacthen and insulin stress tests in the assessment of the hypothalamic-pituitary-adrenal axis [J].
Hurel, SJ ;
Thompson, CJ ;
Watson, MJ ;
Harris, MM ;
Baylis, PH ;
KendallTaylor, P .
CLINICAL ENDOCRINOLOGY, 1996, 44 (02) :141-146
[27]   USERS GUIDES TO THE MEDICAL LITERATURE .3. HOW TO USE AN ARTICLE ABOUT A DIAGNOSTIC-TEST .B. WHAT ARE THE RESULTS AND WILL THEY HELP ME IN CARING FOR MY PATIENTS [J].
JAESCHKE, R ;
GUYATT, GH ;
SACKETT, DL ;
GUYATT, G ;
BASS, E ;
BRILLEDWARDS, P ;
BROWMAN, G ;
COOK, D ;
FARKOUH, M ;
GERSTEIN, H ;
HAYNES, B ;
HAYWARD, R ;
HOLBROOK, A ;
JUNIPER, E ;
LEE, H ;
LEVINE, M ;
MOYER, V ;
NISHIKAWA, J ;
OXMAN, A ;
PATEL, A ;
PHILBRICK, J ;
RICHARDSON, WS ;
SAUVE, S ;
SACKETT, D ;
SINCLAIR, J ;
TROUT, KS ;
TUGWELL, P ;
TUNIS, S ;
WALTER, S ;
WILSON, M .
JAMA-JOURNAL OF THE AMERICAN MEDICAL ASSOCIATION, 1994, 271 (09) :703-707
[28]   VALUE OF AN ACTH TEST IN ASSESSING HYPOTHALAMIC-PITUITARY-ADRENOCORTICAL FUNCTION IN GLUCOCORTICOID-TREATED PATIENTS [J].
KEHLET, H ;
BINDER, C .
BRITISH MEDICAL JOURNAL, 1973, 2 (5859) :147-149
[29]   ADRENOCORTICOTROPIC EFFECTS OF SYNTHETIC POLYPEPTIDE-BETA1-24-CORTICOTROPIN-IN MAN [J].
LANDON, J ;
FRANKLAND, AW ;
WYNN, V ;
CRYER, RJ ;
JAMES, VHT .
JOURNAL OF CLINICAL ENDOCRINOLOGY & METABOLISM, 1964, 24 (11) :1206-+
[30]   Comparison of low and high dose corticotropin stimulation tests in patients with pituitary disease [J].
Mayenknecht, J ;
Diederich, S ;
Bähr, V ;
Plöckinger, U ;
Oelkers, W .
JOURNAL OF CLINICAL ENDOCRINOLOGY & METABOLISM, 1998, 83 (05) :1558-1562