TY - JOUR
T1 - Is the 250 μg ACTH test a useful tool for the diagnosis of central hypoadrenalism in adult patients with pituitary disorders?
AU - Ferrante, Emanuele
AU - Morelli, Valentina
AU - Giavoli, Claudia
AU - Mantovani, Giovanna
AU - Verrua, Elisa
AU - Sala, Elisa
AU - Malcmiodi, Elena
AU - Bergamaschi, Silvia
AU - Profka, Eriselda
AU - Cairoli, Elisa
AU - Palmieri, Serena
AU - Chiodini, Iacopo
AU - Lania, Andrea Gerardo
AU - Spada, Anna
AU - Beck-Peccoz, Paolo
PY - 2012/10
Y1 - 2012/10
N2 - OBJECTIVE: The diagnosis of hypothalamic-pituitary-adrenal insufficiency (HPAI) is a major clinical challenge. The gold standard procedure remains insulin tolerance test (ITT). This study aimed to evaluate the usefulness of standard-dose corticotrophin stimulation test (SDCT) in diagnosing HPAI. DESIGN: In this prospective study we performed SDCT and ITT in 55 consecutive patients (37F/18M) affected by pituitary disorders. RESULTS: A normal response to ITT was found in 44 patients, while HPAI was diagnosed in 11. Using ITT as reference test, the ROC curve showed that a cortisol value of 18 μg/dl (500 nmol/L) at 30 min or 21.8 μg/dl (600 nmol/L) at 60 min after SDCT represents the best compromise between sensitivity and specificity in diagnosing HPAI. Moreover, 30 min cortisol values >20.3 μg/dl (560 nmol/L) or 60 min cortisol values >24.1 μg/dl (665 nmol/L) exclude HPAI. Four out of 15 patients of Group A, previously non-respondent to SDCT, showed a normal response to a second SDCT. CONCLUSIONS: SDCT is not a reliable tool to identify HPAI, but it appears to be more useful in confirming the normality of HPA function. When SDCT fails to exclude HPAI, ITT should be performed. If ITT is contraindicated, retesting patients by SDCT is useful before starting an unnecessary replacement therapy.
AB - OBJECTIVE: The diagnosis of hypothalamic-pituitary-adrenal insufficiency (HPAI) is a major clinical challenge. The gold standard procedure remains insulin tolerance test (ITT). This study aimed to evaluate the usefulness of standard-dose corticotrophin stimulation test (SDCT) in diagnosing HPAI. DESIGN: In this prospective study we performed SDCT and ITT in 55 consecutive patients (37F/18M) affected by pituitary disorders. RESULTS: A normal response to ITT was found in 44 patients, while HPAI was diagnosed in 11. Using ITT as reference test, the ROC curve showed that a cortisol value of 18 μg/dl (500 nmol/L) at 30 min or 21.8 μg/dl (600 nmol/L) at 60 min after SDCT represents the best compromise between sensitivity and specificity in diagnosing HPAI. Moreover, 30 min cortisol values >20.3 μg/dl (560 nmol/L) or 60 min cortisol values >24.1 μg/dl (665 nmol/L) exclude HPAI. Four out of 15 patients of Group A, previously non-respondent to SDCT, showed a normal response to a second SDCT. CONCLUSIONS: SDCT is not a reliable tool to identify HPAI, but it appears to be more useful in confirming the normality of HPA function. When SDCT fails to exclude HPAI, ITT should be performed. If ITT is contraindicated, retesting patients by SDCT is useful before starting an unnecessary replacement therapy.
KW - Central hypoadrenalism
KW - HPAI
KW - ITT
KW - SDCT
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M3 - Article
C2 - 23422765
AN - SCOPUS:84872003265
VL - 11
SP - 428
EP - 435
JO - Hormones
JF - Hormones
SN - 1109-3099
IS - 4
ER -