Comparison of adrenocorticotropin (ACTH) stimulation tests and insulin hypoglycemia in normal humans : Low dose, standard high dose, and 8-hour ACTH-(1-24) infusion tests

The efficacy of the standard high dose ACTH stimulation test (HDT), using a pharmacological 250-microg dose of synthetic ACTH-(1-24), in the diagnosis of central hypoadrenalism is controversial. The insulin hypoglycemia test is widely regarded as the gold standard dynamic stimulation test of the hyp...

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Bibliographic Details
Published in:The journal of clinical endocrinology and metabolism 1999-10, Vol.84 (10), p.3648-3655
Main Authors: NYE, E. J, GRICE, J. E, HOCKINGS, G. I, STRAKOSCH, C. R, CROSBIE, G. V, WALTERS, M. M, JACKSON, R. V
Format: Article
Language:English
Subjects:
Adrenocorticotropic Hormone - blood
Adult
Biological and medical sciences
Chromatography, High Pressure Liquid
Cosyntropin - administration & dosage
Dose-Response Relationship, Drug
Female
Fluorescence Polarization Immunoassay
Functional investigation of endocrine glands and genital system
Humans
Hydrocortisone - blood
Hypoglycemia - blood
Hypoglycemia - chemically induced
Insulin
Investigative techniques, diagnostic techniques (general aspects)
Male
Medical sciences
Middle Aged
Radioimmunoassay
Reference Values
Single-Blind Method
Time Factors
Tropical medicine
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Summary:The efficacy of the standard high dose ACTH stimulation test (HDT), using a pharmacological 250-microg dose of synthetic ACTH-(1-24), in the diagnosis of central hypoadrenalism is controversial. The insulin hypoglycemia test is widely regarded as the gold standard dynamic stimulation test of the hypothalamo-pituitary-adrenal (HPA) axis that provides the most reliable assessment of HPA axis integrity and reserve. Alternatively, a prolonged infusion of ACTH causes a continuing rise in plasma cortisol levels that may predict the adrenals' capacity to respond to severe ongoing stress. In nine normal subjects, we compared plasma ACTH and cortisol levels produced by three i.v. bolus low doses of ACTH-(1-24) (0.1, 0.5, and 1.0 microg/1.73 m2; LDTs) with those stimulated by hypoglycemia (0.15 U/kg insulin) and with the cortisol response to a standard 250-microg dose of ACTH-(1-24). The normal cortisol response to an 8-h ACTH-(1-24) infusion (250 microg at a constant rate over 8 h) was determined using three modern cortisol assays: a high pressure liquid chromatography method (HPLC), a fluorescence polarization immunoassay (FPIA), and a standard RIA. In the LDTs, stepwise increases in mean peak plasma ACTH were observed (12.4 +/- 2.0, 48.2 +/- 7.2, 120.2 +/- 15.5 pmol/L for the 0.1-, 0.5-, and 1.0-microg LDTs, respectively; P values all
ISSN:0021-972X
1945-7197
DOI:10.1210/jc.84.10.3648