Subscribe to RSS
DOI: 10.1055/s-2005-861030
A Hypothetical Index of Hypothalamic-Pituitary-Adrenal (HPA) Axis Function
Publication History
Received 30 March 2004
Accepted after Revision 11 June 2004
Publication Date:
09 February 2005 (online)
Abstract
The short ACTH stimulation test (SST) is commonly used by clinicians to determine the integrity of the hypothalamic-pituitary-adrenal (HPA) axis in cases of suspected adrenal insufficiency. Concern has arisen for under-diagnosis of central hypocortisolism using the standard dose (250mcg) SST with the recent introduction of low-dose (1mcg) SST as a potentially more sensitive test for central hypocortisolism. Amidst this uncertainty, I will present a novel index hypothesized to extend the sensitivity of the standard dose SST as an adjunctive diagnostic tool for any level of hypocortisolism.
Key words
Adrenocortical insufficiency - Corticotropin stimulation test - Mathematical model
References
- 1 Grinspoon S K, Biller B MK. Laboratory assessment of adrenal insufficiency. J Clin Endocrinol Metab. 1994; 79 923-931
- 2 Trainer P J, Faria M, Newell-Price J. et al . A comparison of the effects of human and ovine corticotropin-releasing hormone on the pituitary-adrenal axis. J Clin Endocrinol Metab. 1995; 80 412-417
- 3 Steiner H, Bähr V, Exner P, Oelkers P W. Pituitary function tests: comparison of ACTH and 11-deoxy-cortisol response in the metyrapone test and with the insulin hypoglycemia test. Exp Clin Endocrinol. 1994; 102 33-38
- 4 Oelkers W, Diederich S, Bähr V. Diagnosis and therapy surveillance in Addison’s disease: rapid adrenocorticotropin (ACTH) test and measurement of plasma ACTH, renin activity, and aldosterone. J Clin Endocrinol Metab. 1992; 75 259-264
- 5 Oelkers W, Boelke T, Bähr V. Dose-response relationships between plasma adrenocorticotropin (ACTH), cortisol, aldosterone, and 18-hydroxycorticosterone after injection of ACTH-(1 - 39) or human corticotropin-releasing hormone in man. J Clin Endocrinol Metab. 1988; 66 181-186
- 6 Tordjman K, Jaffe A, Grazas N, Apter C, Stern N. The role of the low dose (1 microgram) adrenocorticotropin test in the evaluation of patients with pituitary disease. J Clin Endocrinol Metab. 1995; 80 1301-1305
- 7 Dickstein G, Shechner C, Nicholson W E. et al . Adrenocorticotropin stimulation test: effects of basal cortisol level, time of day, and suggested new sensitive low dose test. J Clin Endocrinol Metab. 1991; 72 773-778
- 8 Dickstein G, Spigel D, Arad E, Shechner C. One µg is the lowest ACTH dose to cause maximal cortisol response, unrelated to weight. There is no diurnal variation of cortisol response to submaximal ACTH stimulation. Proc of the 79th Annual Meet of The Endocrine Soc. 1997; Oral session OR28-31 997
- 9 Dorin R I, Qualls C R, Crapo L M. Diagnosis of Adrenal Insufficiency. Ann Intern Med. 2003; 139 194-204
- 10 Streeten D H. Shortcomings in the low-dose (1 microg) ACTH test for the diagnosis of ACTH deficiency states [Editorial]. J Clin Endocrinol Metab. 1999; 84 835-837
- 11 Mpoy M, Kolanowski J. Urinary catecholamine excretion in patients with secondary adrenocortical insufficiency. J Endocrinol Invest. 1986; 9 253-255
- 12 Cooper M S, Stewart P M. Corticosteroid insufficiency in acutely ill patients. New Engl J Med. 2003; 348 727-734
- 13 Palermo M, Shackleton C H, Mantero F, Stewart P M. Urinary free cortisone and the assessment of 11-beta-hydroxysteroid dehydrogenase activity in man. Clin Endocrinol. 1996; 45 605-611
Dr. Melvin Khee Shing Leow
Department of Endocrinology, Tan Tock Seng Hospital
11 Jalan Tan Tock Seng · Singapore 308433
Phone: (065) 6-357-7881
Fax: (065) 6-357-7871
Email: mleowsj@massmed.org