Low-Dose ACTH Stimulation Test in Obesity: A Randomized Dose Assessment

Abstract

Background. The short cosyntropin test is widely used for adrenal insufficiency screening and diagnosis. Lower cosyntropin doses may have greater sensitivity vs. the standard dose in detecting adrenal dysfunction. Obesity and overweight are increasing, impacting the clinical presentation of some diseases. Currently more than 50% of the subjects diagnosed with autoimmune adrenal insufficiency have a BMI greater than 25, and hence individuals living with overweight and obesity are more frequently requiring evaluation of the adrenal cortical function. Fixed-dose cosyntropin stimulation may not be appropriate for individuals with obesity. Objective. The primary objective was to compare cortisol response to a weight-adapted cosyntropin dose vs. a fixed low dose (1 µg) and a more physiologically fixed dose (10 µg). Methods. Twenty individuals with obesity and 20 age-matched healthy controls underwent in a randomized sequence at least one-week apart, to the The short cosyntropin test with three different doses, 0.2 µg/kg of body weight, 1 or 10 µg fixed dose stimuli. The assessment and data analysis were blinded to the individual and the investigator. Results. Cortisol response was reduced in the group with obesity with the 1 µg fixed dose stimuli at 30 minutes (median, IQR) 649.6 µg, 567.3–738.4 µg for the control group vs. 568.6 µg, 528.4–623.13 µg, p = 0.04 ; there was a lower cortisol peak at 60′ in all the three evaluated doses, with a dose-dependent trend. A weight-adapted cosyntropin dose of 0.2 µg in obesity produces a similar response to the one observed in individuals without obesity. The 1 µg ACTH test falls short on stimulating the cortisol adrenal response in individuals with obesity.

Determination of cortisol cut-off limits and steroid dynamics in the ACTH stimulation test: a comparative analysis using Roche Elecsys Cortisol II immunoassay and LC-MS/MS

“…Body composition did not affect baseline, 30-and 60min stimulated cortisol concentrations during the ACTH test in men and women, which is in accordance with previous data [25,26]. Another study found that obese men had the same increase in cortisol to ACTH stimulation compared with a normal weight control group which supports our findings [27].…”

Determination of cortisol cut-off limits and steroid dynamics in ACTH stimulation (Synacthen®) test: A comparative analysis using Roche Elecsys Cortisol II immunoassay and LC-MS/MS

“…The body composition factors did not affect the baseline, 30-and 60-minute stimulated cortisol concentrations during the ACTH test in both sexes. which was also shown previously [27,28]. Another study found that obese men had the same increase in cortisol to ACTH stimulation compared with a normal weight control group which supports our ndings [29].…”

Addison’s Disease: Diagnosis and Management Strategies

“…We mention a study on 20 obese individuals (versus 20 controls) comparing a weight-adapted dose (0.2 µg/kg) versus low dose (1 µg) versus high dose (10 µg). At 30 minutes, cortisol levels were lower in the studied group after 1 µg versus controls (p = 0.04); at 60 minutes, cortisol peak was lower in obese group versus controls regardless of the dose of synacthen, thus the test with 1 µg might not be enough, and a 0.2 µg/kg body dose might be useful 37 ( Table 2 ).…”