scholarly journals Accuracy of the Low-Dose ACTH Stimulation Test for Adrenal Insufficiency Diagnosis: A Re-Assessment of the Cut-Off Value

2019 ◽  
Vol 8 (6) ◽  
pp. 806 ◽  
Author(s):  
Laura Maria Mongioì ◽  
Rosita Angela Condorelli ◽  
Federica Barbagallo ◽  
Rossella Cannarella ◽  
Sandro La Vignera ◽  
...  
Keyword(s):  
Adrenal Insufficiency ◽  
Roc Curve ◽  
False Positive ◽  
Low Dose ◽  
Stimulation Test ◽  
High Rate ◽  
Acth Stimulation Test ◽  
Roc Curve Analysis ◽  
Acth Stimulation ◽  
Predictive Values

Background: The clinical practice shows that many low-dose ACTH-stimulation tests have a false positive result. The aim of the study was to determine the diagnostic accuracy of a low-dose ACTH-stimulation test in the diagnosis of adrenal insufficiency and to define its optimal cut-off. Methods: We analyzed data from 103 patients undergoing 1 µg ACTH-stimulation test. Four patients had adrenal insufficiency (AI) upon follow up: Two primary, and two secondary AI. Cortisol serum levels were evaluated at time 0, 20’, and 30’ after the injection of 1 µg i.v. of ACTH. The sensitivity, specificity, accuracy, and positive and negative predictive values of the test were calculated for both 20’ and 30’ sampling. The receiver operating characteristic (ROC) curve was obtained to assess the sensitivity and specificity of low-dose ACTH-stimulation test in the diagnosis of adrenal insufficiency at different cut-off values. Results: Considering 500 nmol/L as the standard cut-off value, low-dose ACTH stimulation test showed a 100% sensitivity and a 67.3% specificity, with a high rate of false positive results. ROC curve analysis showed that the cut-off of 401.5 nmol/L is the best compromise between sensitivity (100%) and specificity (93.9%). Conclusions: By using a cut-off value of 401.5 nmol/L for the low-dose ACTH stimulation test, the number of false positive patients decreased significantly, but the sensitivity remained high.

scholarly journals Evaluating the Low-Dose ACTH Stimulation Test in Children: Ideal Times for Cortisol Measurement

2019 ◽  
Vol 104 (10) ◽  
pp. 4587-4593 ◽  
Author(s):  
Harpreet Gill ◽  
Nick Barrowman ◽  
Richard Webster ◽  
Alexandra Ahmet
Keyword(s):  
False Positive ◽  
Low Dose ◽  
Retrospective Chart Review ◽  
Stimulation Test ◽  
Acth Stimulation Test ◽  
Acth Stimulation ◽  
Incremental Value ◽  
Z Scores ◽  
The Mean ◽  
Cortisol Levels

Abstract Context Central adrenal insufficiency (AI) can be diagnosed with the low-dose ACTH stimulation test (LDST). Protocols determining timing of cortisol sampling vary, with 30 minutes after stimulation being most common. Objectives To determine optimal times to draw cortisol levels and factors predicting timing of peak cortisol levels in children undergoing LDST. Design Retrospective chart review of LDSTs between February 2014 and September 2017. Setting The Children’s Hospital of Eastern Ontario. Patients Patients 3 months to 20 years who underwent LDSTs. Intervention LDSTs were performed with cortisol levels at 0, 15, 30, and 60 minutes after 1 μg cosyntropin. Cortisol values <18 μg/dL (500 nmol/L) determined AI. Main Outcome Measures The incremental value of testing cortisol at 15 or 60 minutes, in addition to the standard 30-minute sample, was estimated. Results A total of 221 patients met inclusion criteria. The mean age was 9.7 years, and 32% were female. Peak cortisol levels were 19%, 67%, and 14% at 15, 30, and 60 minutes, respectively. One false positive LDST result would be prevented for every 24 (95% CI, 13 to 46) or 55 (95% CI, 22 to 141) patients tested at 15 or 60 minutes in addition to the standard 30-minute test. Of the 122 patients who passed the LDST, discontinuing the 15- and 60-minute samples would have misdiagnosed 12 patients (9.8%). Glucocorticoid exposure, age, and body mass index z scores were independent predictors of peak cortisol timing. Conclusion Although the majority of patients peak 30 minutes after cosyntropin administration, testing cortisol levels at 15 and 60 minutes reduces the risk of false positive LDSTs.

P3562Efficient selection of patients with aldosterone-producing adenoma using the ACTH stimulation test

2019 ◽  
Vol 40 (Supplement_1) ◽  
Author(s):  
T Kita ◽  
E Furukoji ◽  
T Sakae ◽  
K Kitamura
Keyword(s):  
Roc Curve ◽  
Challenge Test ◽  
Stimulation Test ◽  
Acth Stimulation Test ◽  
Roc Curve Analysis ◽  
Acth Stimulation ◽  
Plasma Aldosterone Concentration ◽  
Aldosterone Producing Adenoma ◽  
Cortisol Ratio ◽  
Selection Of

Abstract Adrenal venous sampling (AVS) is the gold standard test for distinguishing between unilateral and bilateral primary aldosteronism (PA), however, AVS requires advanced and time consuming technique. The needs for AVS has been increasing due to increased utilization of screening for PA. Efficient selection of unilateral PA, such as aldosterone-producing adenoma (APA), before AVS is useful to avoid undesirable AVS in bilateral PA, such as idiopathic hyperaldosteronism. In this study, 40 patients who underwent all three confirmatory tests including the captopril-challenge test, furosemide upright test and adrenocorticotropin (ACTH) stimulation test (AST), and who were diagnosed as having PA by AVS were recruited. Subjects were diagnosed as having unilateral aldosterone excess (n=22) or bilateral aldosterone excess (n=18) by AVS. All patients with unilateral PA underwent operation and were finally diagnosed with APA. Major differences were detected in serum potassium level, basal plasma aldosterone concentration (PAC), presence of adrenal tumor, and AST results between the two groups. The PAC/cortisol ratio at 120 min in the AST showed the highest diagnostic capability for distinguishing the subtype of PA according to a receiver operating characteristic (ROC) curve analysis (area under the ROC curve was 0.956). At a cut-off value of 1.20 for the PAC/cortisol ratio at 120 min on AST, the sensitivity was 95.5% and the specificity was 88.9%. Sufficiently high sensitivity demonstrated indicates that the PAC/cortisol ratio at 120 min in the AST is useful for selecting patients with PA who are suitable for AVS.

scholarly journals Multidrug-Resistant Tuberculosis and Its Association with Adrenal Insufficiency: Assessment with the Low-Dose ACTH Stimulation Test

2016 ◽  
Vol 2016 ◽  
pp. 1-7 ◽  
Author(s):  
René Rodríguez-Gutiérrez ◽  
Adrian Rendon ◽  
Maximiliano Barrera-Sánchez ◽  
Kevin Erick Gabriel Carlos-Reyna ◽  
Neri Alejandro Álvarez-Villalobos ◽  
...  
Keyword(s):  
Adrenal Insufficiency ◽  
Low Dose ◽  
Multidrug Resistant ◽  
Stimulation Test ◽  
Acth Stimulation Test ◽  
Acth Stimulation ◽  
Resistant Tuberculosis ◽  
Multidrug Resistant Tuberculosis ◽  
Antituberculosis Treatment ◽  
Mdr Tb

Background. Multidrug-resistant tuberculosis (MDR-TB) is a major public health care concern that affects the life of millions of people around the world. The association of tuberculosis and adrenal insufficiency is well known; however, it is thought to be less prevalent every time. A spike in TB incidence and a lack of evidence of this association in patients with MDR-TB call for reassessment of an illness (adrenal dysfunction) that if not diagnosed could seriously jeopardize patients’ health.Objective. To determine the prevalence of adrenocortical insufficiency in patients with MDR-TB using the low-dose (1 μg) ACTH stimulation test at baseline and at 6–12 months of follow-up after antituberculosis treatment and culture conversion.Methods. A total of 48 men or women, aged ≥18 years (HIV-negative patients diagnosed with pulmonary MDR-TB) were included in this prospective observational study. Blood samples for serum cortisol were taken at baseline and 30 and 60 minutes after 1 μg ACTH stimulation at our tertiary level university hospital before and after antituberculosis treatment.Results. Forty-seven percent of subjects had primary MDR-TB; 43.8% had type 2 diabetes; none were HIV-positive. We found at enrollment 2 cases (4.2%) of adrenal insufficiency taking 500 nmol/L as the standard cutoff point value and 4 cases (8.3%) alternatively, using 550 nmol/L. After antituberculosis intensive phase drug-treatment and a negative mycobacterial culture (10.2±3.6months) adrenocortical function was restored in all cases.Conclusions. In patients with MDR-TB, using the low-dose ACTH stimulation test, a low prevalence of mild adrenal insufficiency was observed. After antituberculosis treatment adrenal function was restored in all cases. Given the increasing and worrying epidemic of MDR-TB these findings have important clinical implications that may help clinicians and patients make better decisions when deciding to test for adrenocortical dysfunction or treat insufficient stimulated cortisol levels in the setting of MDR-TB.

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

scholarly journals Low-dose ACTH test for the diagnosis of non-classical form of congenital adrenocortical dysfunction

2010 ◽  
Vol 56 (2) ◽  
pp. 10-14
Author(s):  
N B Chagaĭ ◽  
V V Fadeev ◽  
E G Bakulina
Keyword(s):  
Low Dose ◽  
Stimulation Test ◽  
Acth Test ◽  
Acth Stimulation Test ◽  
Acth Stimulation ◽  
Hydroxylase Deficiency ◽  
Classical Form ◽  
21 Hydroxylase Deficiency

The possibilities to diagnose the non-classical form of 21-hydroxylase deficiency using the low-dose (5 mcg) 1-24 ACTH stimulation test are considered.

scholarly journals OR25-04 Over 14% of Inpatients with Euvolemic Hyponatremia Have Undiagnosed Adrenal Insufficiency

2020 ◽  
Vol 4 (Supplement_1) ◽  
Author(s):  
Amit Kumar ◽  
Maria Ghosh ◽  
Jubbin Jagan Jacob
Keyword(s):  
Adrenal Insufficiency ◽  
Hormone Secretion ◽  
Stimulation Test ◽  
Acth Stimulation Test ◽  
Sheehan’S Syndrome ◽  
Acth Stimulation ◽  
Steroid Use ◽  
Inappropriate Antidiuretic Hormone Secretion ◽  
Inhaled Steroids ◽  
Sheehan's Syndrome

Abstract Background- The commonest cause of euvolemic hyponatremia (EvHNa) is the syndrome of inappropriate antidiuretic hormone secretion (SIADH). The diagnosis of SIADH requires the exclusion of secondary adrenal insufficiency (AI) and untreated hypothyroidism. Studies have suggested about 4% of unselected patients presenting to the emergency room with EvHNa have undiagnosed SAI.1 Among patients admitted to specialized endocrine units this prevalence maybe as high as 20%.2Objective- To study the prevalence of undiagnosed AI among inpatients with EvHNa admitted to general medical wards. Methods- This was a prospective, single centre observational study conducted among inpatients with EvHNa. EvHNa was defined as patients with a serum sodium (Na) &lt;135 mEq/L, with no clinical evidence of dehydration or fluid excess, and a urine spot Na &gt;30mmol/L. In addition patients with recent vomiting, renal failure, recent diuretic use, uncontrolled hyperglycemia and patients with history of use of oral or parenteral steroids in the last 6 months were excluded. Adrenal functions were assessed by a modified porcine ACTH stimulation test which has been described recently by Nair et al. A cut off cortisol value of &lt;18mg/dl after 60 minutes of ACTH injection was used to diagnose AI.3Results- One hundred and forty one (141) patients were included after informed consent and all underwent a modified ACTH stimulation test. They had a mean age of 58 years and 52.3% (n=74) were males. Modified ACTH stimulation testing suggested 20/141 (14.2%) had undiagnosed AI. The mean age among those with AI was 55.2 years. In only 25% (5/20) AI was suspected based on clinical presentation by the treating physician. Despite excluding patients with documented steroid use, the commonest cause of AI (9/20) was secondary AI due to exogenous steroid use including high potency inhaled steroids (5/9) and the use of undocumented steroids or steroid containing medicaments by alternative practitioners (4/9). Hypopituitarism was diagnosed as the cause of AI in 5 patients, which included unsuspected Sheehan’s syndrome in post menopausal women (3/5), non functioning pituitary adenoma (1/5) and lymphocytic hypophysitis (1/5). Despite primary AI not commonly presenting as EvHNa, 3/20 patients had primary AI and in the remaining 3 patients the aetiology of AI remained unclear. Conclusions- Undiagnosed AI is much more common in our country among inpatients presenting with EvHNa to medical units. This increase is primarily driven by inhaled and undocumented exogenous steroid use and undiagnosed Sheehan’s syndrome. An assessment of the hypothalamic-pituitary-adrenal axis is mandatory before making a diagnosis of SIADH. References -(1) Diederich et al. Eur J Endocrinol 2003; 148: 609-617. (2) Cuesta et al. Clin Endocrinol (Oxf) 2016; 85: 836-844. (3) Nair A et al. Eur J Endocrinol. 2019 Oct 1. pii: EJE-19-0558.R2.

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