The use of low doses of ACTH in the investigation of adrenal function in man

Crowley, Suzanne; Hindmarsh, Peter C.; Holownia, Peter; Honour, John W.; Brook, C. G. D.

doi:10.1677/joe.0.1300475

Cited by 139 publications

(90 citation statements)

References 13 publications

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“…We have found that the concentration of ACTH required to obtain the half-maximum cortisol production could vary up to 25-fold depending on the level of cell-to-cell coupling within the cell population. These results provide at least one explanation for the known discrepancy between the Kd value for the interaction of ACTH with its receptor and the ACTH concentrations active on steroidogenesis both in physiological conditions (25,26) and in Cushing's disease (27).…”

Section: Introductionmentioning

confidence: 77%

Gap junction-mediated cell-to-cell communication in bovine and human adrenal cells. A process whereby cells increase their responsiveness to physiological corticotropin concentrations.

Munari-Silem

Lebrethon

Morand³

et al. 1995

J. Clin. Invest.

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Section: Introductionmentioning

confidence: 77%

Gap junction-mediated cell-to-cell communication in bovine and human adrenal cells. A process whereby cells increase their responsiveness to physiological corticotropin concentrations.

Munari-Silem

Lebrethon

Morand³

et al. 1995

J. Clin. Invest.

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“…It has been suggested that the low-dose (0.5-1.0 mg?1.73 m body surface area -2 ) short synacthen test (LDSST) may be more sensitive than the SST in revealing cases of mild adrenal insufficiency [20,25,[28][29][30]. However, ABDU et al [31] found that using the LDSST alone to diagnose adrenal insufficiency lacked specificity with an 11% false-positive rate.…”

Section: Discussionmentioning

confidence: 99%

Adrenal suppression from high-dose inhaled fluticasone propionate in children with asthma: Fig. 1.—

Sim¹,

Griffiths²,

Armstrong³

et al. 2003

Eur Respir J

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This cross-sectional study was designed to examine the prevalence of adrenocortical suppression in children with asthma treated with high-dose inhaled fluticasone propionate (FP).Children and adolescents (n=50) with asthma, treated with inhaled FP at a dose of o1,000 mg a day for o6 months, were enrolled. Early morning serum cortisol was performed. Subjects with a serum cortisol of v400 nmol?L -1 had a tetracosactrin stimulation test.Fifty subjects of mean age 13.1 yrs were treated with a mean dose of 924.7 mg?mFP for a mean duration of 2 yrs. Of the 50 subjects, 36 (72%) had serum cortisol levels of v400 nmol?L -1 and underwent tetracosactrin stimulation test. Of these, 6 (17%) demonstrated a less than two-fold increase in serum cortisol from baseline and peak cortisol level of f550 nmol?L -1 at 30 or 60 min poststimulation. There was a significant negative correlation between the dose of FP?m -2 and stimulated peak cortisol level. Biochemical evidence of adrenocortical insufficiency was demonstrated in 12% of the subjects, indicating that high-dose fluticasone propionate use may be associated with dose-dependent adrenocortical suppression. Eur Respir J 2003; 21: 633-636.

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“…In this context, sensitive tests for assessing adrenal reserve become of significant importance. In recent years, stimulation with low-dose ACTH has been used as a sensitive test to detect subtle changes in adrenal function, which would be missed if the standard ACTH test is used (10)(11)(12). The low-dose ACTH test, following dexamethasone suppression of endogenous ACTH, would therefore be a sensitive method to assess adrenocortical reserve in vivo.…”

Section: Introductionmentioning

confidence: 99%

The effect of thyrotoxicosis on adrenocortical reserve

Tsatsoulis¹,

Johnson²,

Kalogera

et al. 2000

Eur J Endocrinol

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Objective: Variations in thyroid function are known to be associated with changes in adrenocortical activity. Previous studies in animals have suggested that long-standing hyperthyroidism may be associated with diminished adrenal functional reserve despite a continuing hyperactivity of the hypothalamic-pituitary-adrenal (HPA) axis. In humans, there has been no direct assessment of adrenal secretory reserve in clinical thyrotoxicosis. This study aimed to assess adrenocortical reserve in response to low-dose ACTH, following dexamethasone suppression, in patients with severe thyrotoxicosis. Design and methods: Ten patients (four men and six women, 30-45 years) with severe long-standing thyrotoxicosis due to Graves' disease (n = 6) or toxic nodular goitre (n = 4) were studied at diagnosis and again when in a stable euthyroid state following drug therapy for 8-12 months. All patients underwent ACTH stimulation tests at 0800 h with ACTH 1-24 (Cortrosyn; 0.1 mg/kg body weight, i.v.) following overnight suppression of the HPA axis with dexamethasone (1 mg per os at 2300 h). Serum cortisol was assayed at ¹15, 0, 15, 30, 60 and 90 min after the administration of ACTH. Results: The mean (Ϯ S.D.) peak and delta cortisol responses to ACTH (634.5 Ϯ 164 nmol/l and 618 Ϯ 196 nmol/l respectively), as well as the net area under the response curve (36 769 Ϯ 12 188 nmol/l × min) in the hyperthyroid patients were significantly lower compared with the values when the same patients were euthyroid (911 Ϯ 157 nmol/l, 905 Ϯ 160 nmol/l and 57 652 Ϯ 10 128 nmol/l × min respectively; P < 0.005). Subnormal peak cortisol responses (<500 nmol/l) were observed in two severely toxic patients. The findings were independent of the cause of thyrotoxicosis. Conclusion: In patients with severe thyrotoxicosis, cortisol secretion in response to low-dose ACTH stimulation, following dexamethasone suppression, is lower in the hyperthyroid than in the euthyroid state. It appears that thyrotoxicosis is associated with subtle impairment of adrenocortical reserve.

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The use of low doses of ACTH in the investigation of adrenal function in man

Cited by 139 publications

References 13 publications

Gap junction-mediated cell-to-cell communication in bovine and human adrenal cells. A process whereby cells increase their responsiveness to physiological corticotropin concentrations.

Gap junction-mediated cell-to-cell communication in bovine and human adrenal cells. A process whereby cells increase their responsiveness to physiological corticotropin concentrations.

Adrenal suppression from high-dose inhaled fluticasone propionate in children with asthma: Fig. 1.—

The effect of thyrotoxicosis on adrenocortical reserve

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