Zarković M, Cirić J, Stojanović M, Penezić Z, Trbojević B, Drezgić M, Nesovic M
Institute of Endocrinology, University of Belgrade School of Medicine, Yugoslavia.
J Clin Endocrinol Metab. 1999 Sep;84(9):3170-3. doi: 10.1210/jcem.84.9.5947.
ACTH stimulation is the standard test for assessment of adrenal function. It was suggested that the low dose (1 microg) would be more sensitive for detecting mild secondary adrenal insufficiency than the usual dose of 250 microg. The aim of this study was to find the optimal diagnostic criteria and to compare standard dose test (SDT) with the low dose test (LDT). A group of patients treated with corticosteroids for the 6 months was considered to have hypothalamo-pituitary-adrenal impairment. Studies were performed in 14 corticosteroid-treated and 28 control subjects in random order on 2 consecutive days. Tests were analyzed using the receiver operating characteristic curve method. The best test was cortisol increment at 15 min of the LDT. It was significantly better than the cortisol concentration at 15 min of the SDT, the best test during the SDT (receiver operating characteristic curve area and 95% confidence interval: LDT, 0.997 and 0.956-0.999; SDT, 0.827 and 0.662-0.929; P = 0.0113). For the cortisol increment at 15 min of the LDT at 100% sensitivity, the diagnostic value was 100 mmol/L, and the specificity was 96%. Therefore, the LDT is superior to the standard dose test in the assessment of secondary adrenal insufficiency.
促肾上腺皮质激素（ACTH）刺激试验是评估肾上腺功能的标准测试。有人认为，低剂量（1微克）在检测轻度继发性肾上腺功能不全方面比通常的250微克剂量更敏感。本研究的目的是找到最佳诊断标准，并将标准剂量试验（SDT）与低剂量试验（LDT）进行比较。一组接受皮质类固醇治疗6个月的患者被认为存在下丘脑-垂体-肾上腺功能损害。对14名接受皮质类固醇治疗的患者和28名对照受试者连续两天按随机顺序进行研究。使用受试者工作特征曲线法对测试进行分析。最佳测试是低剂量试验15分钟时的皮质醇增量。它明显优于标准剂量试验15分钟时的皮质醇浓度，标准剂量试验中的最佳测试（受试者工作特征曲线面积和95%置信区间：低剂量试验，0.997和0.956 - 0.999；标准剂量试验，0.827和0.662 - 0.929；P = 0.0113）。对于低剂量试验15分钟时皮质醇增量在100%敏感性下，诊断值为100毫摩尔/升，特异性为96%。因此，在评估继发性肾上腺功能不全方面，低剂量试验优于标准剂量试验。
