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PubMed2005

A comparison between the effects of low (1 microg) and standard dose (250 microg) acth stimulation tests on adrenal cortex functions with leprosy patients.

Leprosy is a chronic granulomatous disease that either remains localized or widespread depending on the immunological status of the affected patient. It can lead to clinical or subclinical adrenal failure by influencing adrenal steroidogenesis. In the present study, 26 patients (21 males and 5 females) who were diagnosed with lepromatous leprosy and 15 healthy individuals who were compatible with the patients in terms of age and sex were subjected to an adrenocorticotrophic hormone (ACTH) stimulation test. The leprosy and control groups were subjected to 1microg low dose (LDT) and 250 microg intravenous standard dose (SDT) ACTH stimulation tests after 12-hour nocturnal fasting with an interval of three days. Cortisol responses in 0, 30, and 60 minutes were examined. There was no difference between leprosy and control groups in terms of mean baseline cortisol values. Mean value of the peak cortisol response to both LDT and SDT was found to be significantly lower in the leprosy group than in the control group (p < 0.001 and p < 0.01, respectively). Peak cortisol response to LDT in the leprosy group was found below 20 microg/dL in 9 patients (34.6%). As for the peak cortisol response to SDT, it was lower than 20 microg/dL, in 5 patients (19.23%). It was found that LDT response was abnormally low in 4 patients (15.38%) who responded normally to SDT. It was observed that there could be a decrease in adrenocortical reserve capacity although baseline adrenocortical functions were normal in patients with leprosy. It was seen that LDT was more sensitive than SDT in identifying this decrease.

Adrenal Cortex↗
PubMed1986

[Cushing's syndrome 1985: current views and possibilities].

According to the current view a semiautonomously ACTH-producing pituitary microadenoma is the true cause of pituitary-dependent Cushing's syndrome in most instances. Only exceptionally does the disease seem to be caused by a functional pituitary or hypothalamic disturbance of cortisol regulation. A newly discovered rare etiology is ectopic production of CRF. Cushing's syndrome is still most reliably diagnosed by abnormal adrenocortical function tests based on corticosteroid determinations. However, determination of plasma ACTH concentrations and computer-assisted tomography of the pituitary or adrenal glands have become useful tools in differentiating the various forms of Cushing's syndrome. Although a considerable number of available drugs provide effective chemotherapy for Cushing's syndrome, surgical elimination of ACTH-producing or cortisol-producing tumors is still the therapy of choice in most cases.

Adenoma↗
PubMed1987

Diagnosis and treatment of functioning and nonfunctioning adrenocortical neoplasms including incidentalomas.

The most important functional tumors of the adrenal cortex are those that secrete cortisol or aldosterone in excess. Biochemical testing when appropriately utilized can diagnose and differentiate the cause of Cushing's syndrome, and when an adrenal adenoma is found, surgical excision is curative. The diagnosis and surgical treatment of primary aldosteronism are straightforward today, and localization of the usual small cortical tumor producing the syndrome can be achieved by CT and NP-59 scanning or selective venous assays. Adrenocortical carcinomas are relatively rare, are usually incurable when diagnosed, and are an important consideration in the incidentally discovered adrenal mass found by CT scanning.

Adenoma↗
PubMed1977

Short time kinetics of deoxycorticosterone, deoxycortisol, corticosterone and cortisol during single dose metyrapone test.

In 4 young healthy males, serum levels of 11-deoxycortisol (S), cortisol (F), 11-deoxycorticosterone (DOC) and corticosterone (B) were determined at short intervals after oral administration of 30 mg/kg of metyrapone (M) at midnight. 11-hydroxylase blockade was calculated from the formula (formula: see text). Significant blockade was demonstrable 15 to 30 min after drug administration. Maximum blockade (greater than 90%) was found between 2 and 4 a.m., and fell to 60-70% at 8 a.m. The profile of blockade was very similar in all the subjects, although the absolute early rise in steroid levels showed large inter-individual differences. The F level at 8 a.m. (only slightly suppressed under these conditions) is not a safe indicator of adequate 11-hydroxylase blockade.

Administration, Oral↗
PubMed1991

[The diagnosis of Cushing's syndrome. Results of diagnostic assessment of 20 patients with Cushing's syndrome of variable etiology (1979-1989)].

In the light of 20 cases of Cushing's syndrome the currently used diagnostic strategies are presented. For initial screening the classical dexamethasone suppression test using 1 mg dexamethasone p.o. and 24-hour urinary extraction of free cortisol were used, and diagnosis was confirmed using the 2 mg dexamethasone suppression test for two days. All three tests had a sensitivity of 100% in these 20 patients. Etiological evaluation was performed using basal ACTH plasma concentration measurement and the more recently available stimulation tests using corticotropin-releasing factor (CRF): in cases with suspected pituitary-hypothalamic etiology, selective catheterisation of the sinus petrous inferior with simultaneous blood sampling for measurement of plasma ACTH concentration was performed. Detailed etiological diagnosis is important in Cushing's syndrome since therapeutic measures differ widely: the etiologies in the 20 patients with Cushing's syndrome were: central Cushing's disease (microadenoma in 11, pituitary carcinoma in 1), adrenal carcinoma (3), adrenal adenoma (1), adrenal hyperplasia (1), ectopic ACTH production (2) and alcohol-induced Cushing's syndrome (1). The stepwise procedure in screening and diagnosis of the various etiologies of Cushing's syndrome are presented and the results of the 20 patients compared with the literature.

Adrenal Cortex Function Tests↗
PubMed1984

Adrenocortical reserve of neonates born of long-term, steroid-treated mothers.

Since corticosteroids have been shown to be transferred across the human placenta, prolonged administration of these drugs during gestation could be expected to suppress the response of the neonatal adrenal gland. Plasma cortisol levels, before and 30 min after the injection of ACTH (36 micrograms/kg), were determined in six neonates who were exposed in utero to prolonged maternal administration of prednisone. The basal plasma cortisol levels of these neonates (6.15 +/- 2.57 micrograms %; mean +/- SEM) were similar to values obtained in eight healthy neonates (5.19 +/- 1.36 micrograms %). The increment of cortisol levels after ACTH stimulation (16.4 +/- 2.07 micrograms %) of the study patients was larger (P less than 0.01) than the change (10.3 +/- 0.82 micrograms %) observed in six older controls. These results indicate a normal neonatal adrenal reserve after prolonged exposure to corticosteroids during fetal life.

Adolescent↗
PubMed2006

Value of basal serum cortisol to detect corticosteroid-induced adrenal insufficiency in elite cyclists.

The frequent use of glucocorticoids by athletes necessitates testing for adrenal insufficiency because of the risk of death in cases of associated severe stress (trauma, infection). During the 2001 and 2002 sporting seasons, we assessed the value of measuring baseline serum cortisol concentrations and the frequency of corticosteroid use during compulsory medical tests carried out by the French Cycling Federation on 659 elite cyclists (585 men and 74 women); the risk of adrenal insufficiency is negatively correlated with the basal serum cortisol level. Adrenal insufficiency was suspected in 34 cyclists (5.2%; 22 in 2001 and 12 in 2002) on the basis of below normal cortisol concentrations and in three cyclists (in 2001) because they had received corticosteroid treatment. In 2001, 10 of the 25 cyclists convoked underwent baseline follow-up serum cortisol determinations and 15 underwent dynamic exploration of adrenal function with the short ACTH test. Adrenal function was found to be deficient in four of these cyclists, at the limits of the normal range in four and normal in seven. Based on these results, the FFC sent a questionnaire in 2002 to all the cyclists to assess the use of corticosteroid in this population. This survey revealed that 85 of 538 cyclists (15.8%) had received corticosteroid treatment in the previous 3 months. Moreover, 11 of the 12 cyclists (92%) with low basal serum cortisol concentrations had received corticosteroid therapy. These results show that basal serum cortisol is relevant to detect adrenal insufficiency in sportsmen, in particular in cases of values below the normal range. The high frequency of corticosteroid use among elite cyclists, and in particular road cyclists who are at risk of trauma and infection, justifies screening tests to detect adrenal insufficiency.

Adrenal Cortex Function Tests↗