González-González J G, De la Garza-Hernández N E, Mancillas-Adame L G, Montes-Villarreal J, Villarreal-Pérez J Z
Dr José Eleuterio González University Hospital, Monterrey Nuevo León, México. Sub-Dirección de Investigación y Estudios de Pos-Grado, Ave Madero y Gonzalitos, Monterrey Nuevo León, Apartado Postal 4355-H, México.
J Endocrinol. 1998 Nov;159(2):275-80. doi: 10.1677/joe.0.1590275.
The short cosyntropin (synthetic ACTH) test is recognized as the best screening manoeuvre in the assessment of adrenocortical insufficiency. Recent data, however, suggest that i.v. administration of 250 microg cosyntropin could be a pharmacological rather than a physiological stimulus, losing sensitivity for detecting adrenocortical failure. Our objective was to compare 10 vs 250 microg cosyntropin in order to find differences in serum cortisol peaks in healthy individuals, the adrenocortical response in a variety of hypothalamic-pituitary-adrenal axis disorders and the highest sensitivity and specificity serum cortisol cut-off point values. The subjects were 83 healthy people and 37 patients, the latter having Addison's disease (11), pituitary adenomas (7), Sheehan's syndrome (9) and recent use of glucocorticoid therapy (10). Forty-six healthy subjects and all patients underwent low- and standard-dose cosyntropin testing. In addition, 37 controls underwent the low-dose test. On comparing low- and standard-dose cosyntropin testing in healthy subjects there were no statistical differences in baseline and peaks of serum cortisol. In the group of patients, 2 out of 11 cases of Addison's disease showed normal cortisol criterion values during the standard test but abnormal during the low-dose test. In our group of patients and controls, the statistical analysis displayed a better sensitivity of the low-dose vs standard-dose ACTH test at 30 and 60 min. In conclusion, these results suggest that the use of 10 microg rather than 250 microg cosyntropin i.v. in the assessment of suspicious adrenocortical dysfunction gives better results.
短程促肾上腺皮质激素（合成促肾上腺皮质激素）试验被认为是评估肾上腺皮质功能不全的最佳筛查方法。然而，最近的数据表明，静脉注射250微克促肾上腺皮质激素可能是一种药理刺激而非生理刺激，在检测肾上腺皮质功能衰竭方面失去了敏感性。我们的目的是比较10微克和250微克促肾上腺皮质激素，以找出健康个体血清皮质醇峰值的差异、各种下丘脑-垂体-肾上腺轴疾病中的肾上腺皮质反应以及最高敏感性和特异性的血清皮质醇临界值。受试者包括83名健康人和37名患者，后者患有艾迪生病（11例）、垂体腺瘤（7例）、席汉综合征（9例）以及近期使用糖皮质激素治疗（10例）。46名健康受试者和所有患者接受了低剂量和标准剂量的促肾上腺皮质激素试验。此外，37名对照者接受了低剂量试验。比较健康受试者的低剂量和标准剂量促肾上腺皮质激素试验，血清皮质醇的基线和峰值无统计学差异。在患者组中，11例艾迪生病患者中有2例在标准试验中皮质醇标准值正常，但在低剂量试验中异常。在我们的患者组和对照组中，统计分析显示低剂量促肾上腺皮质激素试验在30分钟和60分钟时比标准剂量试验具有更好的敏感性。总之，这些结果表明，在评估可疑肾上腺皮质功能障碍时，静脉注射10微克而非250微克促肾上腺皮质激素能得出更好的结果。
