Division of Endocrinology, Georgetown University Medical Center, Washington, DC 20007, USA.
Endocr Pract. 2012 Jan-Feb;18(1):66-75. doi: 10.4158/EP11085.OR.
To determine whether the time of day at which corticotropin stimulation testing is performed influences the steroid concentrations observed in persons with normal adrenal function.
In this retrospective, secondary analysis, participants with normal adrenal function were studied to determine whether the time of corticotropin stimulation testing influenced results. Participants consisted of 2 groups: healthy volunteers who were not suspected of having adrenal insufficiency and patients being tested for adrenal insufficiency as part of their standard of care who were subsequently shown to have normal adrenal function on the basis of a peak cortisol value of at least 20 μg/dL. A high-dose corticotropin stimulation test was performed in all participants. Baseline, peak, and delta steroid concentrations were documented after corticotropin injection. Steroid concentrations were measured by tandem mass spectrometry. Multivariate analyses adjusted for patient age, sex, and baseline steroid concentrations.
With progression through the day for the time of testing, the baseline cortisol concentration decreased, while the peak and delta cortisol concentration increased (P values: <.001, .007, .007, respectively). For 11-deoxycortisol, the baseline decreased, while peak and delta values increased with later testing (P values: .017, .012, .02, respectively). Peak aldosterone concentrations increased according to their baseline values (P<.001), but were unaffected by time. Peak and delta dehydroepiandrosterone concentrations increased with time (P = .015 and .021, respectively). Referring to the various criteria for adequate steroid responses to corticotropin available in the literature, the time-related differences in this small group of patients were insufficient to draw different conclusions about results of testing.
Cortisol, 11-deoxycortisol, and dehydroepiandrosterone values were most influenced by testing times. In patients with borderline adrenal function who are tested at different times of the day, the modest differences we observed may be sufficient to affect conclusions about whether adrenal insufficiency is present.
确定促皮质素刺激试验进行的时间是否会影响正常肾上腺功能个体中观察到的类固醇浓度。
在这项回顾性二次分析中，研究了具有正常肾上腺功能的参与者，以确定促皮质素刺激试验的时间是否会影响结果。参与者分为 2 组：未怀疑患有肾上腺功能不全的健康志愿者和作为标准护理一部分接受肾上腺功能不全检查的患者，随后根据至少 20μg/dL 的峰值皮质醇值显示正常肾上腺功能。所有参与者均进行了大剂量促皮质素刺激试验。记录促皮质素注射后的基线、峰值和 delta 类固醇浓度。类固醇浓度通过串联质谱法测量。多元分析调整了患者年龄、性别和基线类固醇浓度。
随着测试时间的推移，基线皮质醇浓度逐渐降低，而峰值和 delta 皮质醇浓度逐渐升高（P 值：<.001，.007，.007，分别）。对于 11-脱氧皮质醇，基线降低，而峰值和 delta 值随着后期测试而增加（P 值：.017，.012，.02，分别）。醛固酮的峰值浓度根据其基线值增加（P<.001），但不受时间影响。峰值和 delta 脱氢表雄酮浓度随时间增加（P=.015 和.021，分别）。根据文献中可获得的促皮质素对类固醇反应的各种标准，这个小患者群体的时间相关差异不足以得出关于测试结果的不同结论。
皮质醇、11-脱氧皮质醇和脱氢表雄酮值受测试时间的影响最大。在每天不同时间接受测试的边缘肾上腺功能患者中，我们观察到的适度差异可能足以影响关于是否存在肾上腺功能不全的结论。
