Clark P M, Neylon I, Raggatt P R, Sheppard M C, Stewart P M
Regional Endocrine Laboratory, University Hospital Birmingham NHS Trust, UK.
Clin Endocrinol (Oxf). 1998 Sep;49(3):287-92. doi: 10.1046/j.1365-2265.1998.00555.x.
To define the normal cortisol response to the Short Synacthen Test using four different cortisol immunoassays and to assess the implications for the investigation of hypothalamic-pituitary disorders.
The cortisol response to 250 micrograms im ACTH1-24 (Synacthen, Ciba Geigy) in 100 healthy volunteers using four different cortisol immunoassays has been measured. In 44 newly diagnosed and untreated patients with pituitary disease, basal and 30 minute post-ACTH cortisol results were also determined using the four immunoassays.
The distribution of cortisol results at all time points and for all methods were non-Gaussian and significant differences in the absolute values of the 5th-95th percentiles were found between methods (P < 0.01). At 30 min post-Synacthen in normals the 5th percentile of the cortisol response ranged from 510 to 626 nmol/l with the different methods. Similarly the relationship between assay results differed at different time points. No effect of age on the cortisol response was found but for stimulated cortisol values and the incremental responses females showed significantly higher responses than males (P < 0.05) for most methods. Although there was a significant positive linear correlation (P < 0.001) between stimulated and basal cortisol values for all methods, no significant relationship was found between the incremental response and basal cortisol values. In the pituitary disease patients basal and 30 minute post-ACTH cortisol results were significantly lower (P < 0.05 and < 0.001) than the control group using the same cortisol assay. When the results were compared to the 5th percentile of the gender and assay specific control group 33.3% of male and 17.4% of female patients failed the Synacthen test at 30 min.
The definition of the 'normal' response to Synacthen should be both gender and method related at all time points. The data suggest that up to one-third of untreated patients with pituitary disease may have subtle defects in the hypothalamic-pituitary-adrenal axis.
使用四种不同的皮质醇免疫测定法来定义对短促肾上腺皮质激素试验的正常皮质醇反应，并评估其对下丘脑 - 垂体疾病调查的意义。
使用四种不同的皮质醇免疫测定法，测量了100名健康志愿者对250微克肌肉注射促肾上腺皮质激素1 - 24（合成促肾上腺皮质激素，汽巴 - 嘉基公司）的皮质醇反应。对于44名新诊断且未接受治疗的垂体疾病患者，也使用这四种免疫测定法测定了基础和促肾上腺皮质激素刺激后30分钟的皮质醇结果。
所有时间点和所有方法的皮质醇结果分布均不符合高斯分布，不同方法之间第5 - 95百分位数的绝对值存在显著差异（P < 0.01）。在正常人群中，合成促肾上腺皮质激素刺激后30分钟，不同方法测得的皮质醇反应第5百分位数范围为510至626纳摩尔/升。同样，不同时间点的测定结果之间的关系也有所不同。未发现年龄对皮质醇反应有影响，但对于刺激后的皮质醇值和增量反应，在大多数方法中，女性的反应明显高于男性（P < 0.05）。尽管所有方法的刺激后和基础皮质醇值之间存在显著的正线性相关性（P < 0.001），但增量反应与基础皮质醇值之间未发现显著关系。在垂体疾病患者中，使用相同的皮质醇测定法，基础和促肾上腺皮质激素刺激后30分钟的皮质醇结果显著低于对照组（P < 0.05和< 0.001）。当将结果与性别和测定法特定对照组的第5百分位数进行比较时，33.3%的男性和17.4%的女性患者在30分钟时促肾上腺皮质激素试验未通过。
对合成促肾上腺皮质激素的“正常”反应的定义在所有时间点都应与性别和方法相关。数据表明，多达三分之一未接受治疗的垂体疾病患者可能在下丘脑 - 垂体 - 肾上腺轴存在细微缺陷。
