Program in Reproductive and Adult Endocrinology, National Institute of Child Health and Human Development Pharmacy Department, National Institutes of Health, Clinical Center, Bethesda, Maryland, USA.
Eur J Endocrinol. 2010 Jan;162(1):109-13. doi: 10.1530/EJE-09-0746. Epub 2009 Oct 1.
To examine the factors causing inadequate cortisol responses to the 1 microg ACTH stimulation test.
Random test assignment (by age and gender) at 0800 or 1600 h.
We recruited 20 healthy adults to each of the three age groups (<40 years, 40-55 years, and >55 years; half females in each group). ACTH stimulation tests were performed in an outpatient clinic at the NIH Clinical Research Center. Plasma cortisol was measured just before, and 30 and 60 min after the administration of 1 microg ACTH (1-24). The ACTH concentration in diluted and administered solutions was measured.
Twenty-five volunteers (19 at 1600 h) had a subnormal cortisol response (peak cortisol 10.4-17.5 microg/dl), using a criterion <18 microg/dl (497 nmol/l), for a specificity of 58% (confidence interval (CI) 45-71%). Afternoon testing had a significant impact on failure rates (odds ratio 6.98, CI 2.17-22.43), while gender and age did not. The stock solution contained 1 microg ACTH, but after administration through tubing it contained only 0.5-0.8 microg.
The high rate of abnormal results, especially in the afternoon, and loss of ACTH through tubing suggest that morning testing and minimal tubing should be adopted to avoid an inappropriate diagnosis of adrenal insufficiency. Earlier time points and standardized protocols would facilitate comparison of studies.
探讨导致 1μgACTH 刺激试验皮质醇反应不足的因素。
0800 或 1600 时按年龄和性别随机分组进行检测。
我们招募了 20 名健康成年人，每个年龄组（<40 岁、40-55 岁和>55 岁；每组各有一半女性）各 20 名。ACTH 刺激试验在 NIH 临床研究中心的门诊进行。在给予 1μgACTH（1-24）前、后 30 和 60 分钟测量血浆皮质醇。测量了稀释和给予的溶液中的 ACTH 浓度。
25 名志愿者（19 名在 1600 时）的皮质醇反应异常（峰值皮质醇 10.4-17.5μg/dl），采用<18μg/dl（497nmol/l）的标准，特异性为 58%（置信区间 45-71%）。下午检测对失败率有显著影响（比值比 6.98，置信区间 2.17-22.43），而性别和年龄没有。储备溶液中含有 1μgACTH，但通过管道给药后仅含有 0.5-0.8μg。
异常结果的高发生率，尤其是下午，以及通过管道丢失 ACTH，提示应采用上午检测和最小化管道以避免不适当的肾上腺功能不全诊断。更早的时间点和标准化方案将有助于比较研究。
