Kosak M, Duskova M, Starka L, Jandikova H, Pospisilova H, Sramkova M, Hana V, Krsek M, Springer D, Simunkova K
Third Department of Medicine, Department of Endocrinology and Metabolism, First Faculty of Medicine, Charles University and General University Hospital in Prague, Czech Republic, Institute of Endocrinology, Prague, Czech Republic.
Physiol Res. 2017 Sep 26;66(Suppl 3):S387-S395. doi: 10.33549/physiolres.933729.
Criteria for the evaluation of the insulin tolerance test (ITT) and Synacthen test are still a matter of debate. The objective of the study was to make a comparison of serum and salivary cortisol during four stimulation tests. Sixty four healthy volunteers underwent the ITT, the Synacthen test with 1 (LDST), 10 (MDST) and 250 (HDST) microg dose of ACTH. Maximum serum cortisol response was observed at the 90 min of the ITT (49 %), HDST (89 %) and MDST (56 %) and at the 40 min of the LDST (44 %). Results expressed as 95 % confidence intervals: 408.0-843.6 and 289.5-868.1 nmol/l in the IIT at 60 and 90 min. In the HDST and the MDST serum cortisol reached the maximum at 90 min 542.6-1245.5 and 444.2-871.3 nmol/l. Levels of salivary cortisol followed the same pattern as serum cortisol. Salivary cortisol reached the maximum response in the HDST and the MDST at 90 min and at 40 min in the LDST. We confirmed good reliability of all tests with respect to timing of response and maximum response compared to the ITT. We proved that the MDST test can provide the similar response in serum cortisol to the HDST. Measuring either salivary cortisol or ACTH levels did not provide any additional benefit then measuring serum cortisol by itself.
胰岛素耐量试验（ITT）和促肾上腺皮质激素释放激素试验（Synacthen test）的评估标准仍存在争议。本研究的目的是比较四种刺激试验期间血清和唾液皮质醇的情况。64名健康志愿者接受了ITT、分别使用1微克（低剂量促肾上腺皮质激素释放激素试验，LDST）、10微克（中剂量促肾上腺皮质激素释放激素试验，MDST）和250微克（高剂量促肾上腺皮质激素释放激素试验，HDST）促肾上腺皮质激素（ACTH）的Synacthen试验。在ITT的90分钟（49%）、HDST（89%）和MDST（56%）以及LDST的40分钟（44%）时观察到血清皮质醇的最大反应。结果以95%置信区间表示：在ITT中，60分钟和90分钟时分别为408.0 - 843.6和289.5 - 868.1纳摩尔/升。在HDST和MDST中，血清皮质醇在90分钟时达到最大值，分别为542.6 - 1245.5和444.2 - 871.3纳摩尔/升。唾液皮质醇水平与血清皮质醇遵循相同模式。唾液皮质醇在HDST和MDST的90分钟以及LDST的40分钟时达到最大反应。与ITT相比，我们证实了所有试验在反应时间和最大反应方面具有良好的可靠性。我们证明MDST试验在血清皮质醇方面可提供与HDST相似的反应。与单独测量血清皮质醇相比，测量唾液皮质醇或ACTH水平并未带来任何额外益处。
