Adrenocortical Stimulation Tests with ACTH: Developments and Changes of a Diagnostic Procedure

Knappe, G

doi:10.1159/000178226

Cited by 2 publications

(2 citation statements)

References 66 publications

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“…Since the non-tumorous adrenal glands of these dogs were found to be atrophied it is most unlikely that they were the source of this increase. In man, patients with Cushing's syndrome due to adrenocortical tumours also often have increased plasma concentrations of cortisol after administration of corticotrophin (ACTH) (Ernest, 1966;Martin & Hamman, 1966;Sparks, Smilo, Pavlatos «fe Forsham, 1969;Crystal, Rose, Jagger & Lauler, 1970;Knappe, 1971 ;Rayfield, Rose, Cain, Dluhy «fe Williams, 1971 ;Harrison, Mahoney & Bennett, 1973). Thus in both species the diagnosis of an adrenocortical tumour cannot be excluded on the basis of responsiveness to ACTH.…”

Section: Resultsmentioning

confidence: 99%

Adrenocortical Function Tests in Dogs With Hyperfunctioning Adrenocortical Tumours

Meijer¹,

Lubberink²,

Rijnberk³

et al. 1979

Journal of Endocrinology

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The response has been studied in nine dogs with hyperadrenocorticism due to adrenocortical tumours to the administration of dexamethasone, insulin, lysine-vasopressin and tetracosactide by measuring the changes in plasma cortisol concentration. Administration of dexamethasone did not produce a decrease in the plasma concentration of cortisol in any of these dogs. Administration of insulin caused slight increases in the plasma concentration of cortisol in four out of eight dogs. Lysine-vasopressin increased the plasma concentration of cortisol in eight out of nine dogs, three responded supranomally. Eight out of the nine dogs responded to tetracosactide administration, three responded supranormally, It is concluded that in the dog, in contrast to man, the lysine-vasopressin test cannot be used to differentiate between pituitary-dependent hyperadrenocorticism and hyperadrenocorticism due to an adenocortical tumour. Apparently pituitary ACTH is not completely depleted in dogs with hyperfunctioning adrenocortical tumours.

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Section: Resultsmentioning

confidence: 99%

Adrenocortical Function Tests in Dogs With Hyperfunctioning Adrenocortical Tumours

Meijer¹,

Lubberink²,

Rijnberk³

et al. 1979

Journal of Endocrinology

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“…If a random response is obtained just below this zone similar test has been used by Feurle et al (15). The 2-hr test of uncertainty there is a 4 % probability that it represents an appears to be diagnostically superior to the commonly used 0.5-individual whose characteristic response is above the lower hr test (41) and to the 1-hr test (23,31,33,35), and will often normal limit. Similarly, a response just above this zone of serve as a definitive diagnostic procedure, particularly for the uncertainty may be taken as evidence of normality of response combined insulin-ACTH test.…”

Section: Acth T E ( I T ~-~ Cortisol Level P M M M Lmentioning

confidence: 99%

Two-hour Adrenocorticotropic Hormone Test: Accuracy in the Evaluation of the Hypothalamic- Pituitary-Adrenocortical Axis

Leisti

Perheentupa

1978

Pediatr Res

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Summary subnormal basal and stimulated levels. Thus the ACTH test didThe inter-and intraindividual variations of response to an iv not diierentiate this state from ACTH deficiency.bolus of tetracosactide (0.25 mgl1.73 m2) were studied, and a definitive diagnostic 2-hr test was established. The test was Speculation given to 179 subjects: hypopituitary, prednisone-treated nephrotics, patients with the autoimmune polyendocrinopathyWhen the Witeria for a in the 2-hr iv ACTH candidinsis syndrome (APECS), and reference subjects. ~t was test have been carefully established, this test will serve as a repeated in 62 cases and the total of 84 test pairs was analyzed. definitive procedure for the diagnosis and follow-up of states me test was either at 8-9 AM or at 10-11 AM, 2 hr associated with ACTH deficiency, as well as in primary diseases after the injection of insulin for an insulin test. Thirty subjects of the adrenal cortex. Like the other ACTH tests, however, it had both the A~H test and the i n s u l i n -~~~H test. capillary will not diierentiate with certainty between primary and secondblood samples for fluorometric determination of plasma cortisol ary adrenOcOrtical were taken 1 , 2 , and 3 hr after the injection.The distributions of the basal and stimulated levels were positively skewed, and log transformation of the data gaveIn the diagnosis of adrenocortical failure, stimulation with a clearly more appropriate statistics. In most subjects the single dose of exogenous ACTH with determination of the level was highest 2 hr &ter the injection. There was no swifiresponse in plasma cortisol level has partly replaced longer tests. cant difference in the response to ACTH whether it was Bven The shortest test in wide use consists of an im or iv injection of alone or in the insulin-ACTH test. All the poststimulation the 1-24 peptide (20,24,38) and determination of plasma cortisol levels showed a positive interindividual correlation with cortisol before and 30 min after the injection (4, 11, 18, 37, 39, the basal levels, and all the increments a negative interindividual 41). However, this test is not accurate, and it is used mainly as correlation with the basal levels.a screening procedure, with variable criteria for a normal reIn repented tests, the intraindividunl variation in the responses sponse. In none of the 1 to 3-hr tests so far introduced have was &redly correlated with the level of the response, and this criteria for a normal response been adequately established on a correlation could be removed by dividing the intrapair difference theoretically sound basis (23, 3 1-33, 35, 42). We have made a in the values of the parameters by the sum of the values for careful evaluation of a 2-hr ACTH test, which we here propose percentage of intrapair difference (PIPD). m e SD of the for a definitive diagnostic procedure. A preliminary report has distribution of PIPDs was used for an index of precision. The 2-appeared (28). hr cortisol level was substantially more precise than either the basal level or the increment. In an...

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Adrenocortical Stimulation Tests with ACTH: Developments and Changes of a Diagnostic Procedure

Cited by 2 publications

References 66 publications

Adrenocortical Function Tests in Dogs With Hyperfunctioning Adrenocortical Tumours

Adrenocortical Function Tests in Dogs With Hyperfunctioning Adrenocortical Tumours

Two-hour Adrenocorticotropic Hormone Test: Accuracy in the Evaluation of the Hypothalamic- Pituitary-Adrenocortical Axis

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