The low-dose ACTH stimulation test: is 30 minutes long enough?
The low-dose ACTH stimulation test: is 30 minutes long enough?
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DOI：
10.4158/ep14423.or
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发表时间：
2015-05
期刊：
影响因子：
--
通讯作者：
Misra M
中科院分区：
文献类型：
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作者：
Cartaya J;Misra M
关于使用低剂量促肾上腺皮质激素（ACTH）刺激试验（LDST）诊断肾上腺功能不全（AI）和最佳试验结果解释的争议仍然存在。然而，许多中心现在使用LDST来评估皮质醇分泌充足性，有些中心仅使用30分钟的皮质醇水平来确定肾上腺充足性或AI。这项研究检查了30分钟和60分钟的皮质醇水平，以评估当考虑到两种皮质醇水平时，测试的解释是否受到影响。通过回顾性病历审查从一个儿科内分泌科获得了7年的数据。我们确定了82名完成LDST的患者。他们的平均年龄为11.7岁，37%为女性。皮质醇水平在基线和促皮质激素给药后30和60分钟进行评价。临界值≥18 μg/dL用于定义肾上腺功能充足。我们发现54%的患者在60分钟时达到皮质醇峰值水平，11名在30分钟时未通过测试的患者在60分钟时通过了测试。唯一的预测特征是体重状况;超重和肥胖个体倾向于在30分钟达到峰值，正常和体重不足个体倾向于在60分钟达到峰值。虽然需要进一步的研究来证实我们的发现，但似乎有必要在合成ACTH给药后30分钟和60分钟测量皮质醇，以避免过度诊断AI。
Controversy persists regarding the use of the low-dose adrenocorticotropic hormone (ACTH) stimulation test (LDST) for the diagnosis of adrenal insufficiency (AI) and optimal test result interpretation. However, many centers are now using the LDST to assess cortisol secretion adequacy, and some only use a 30-minute cortisol level to determine adrenal sufficiency or AI. This study examined both 30- and 60-minute cortisol levels to assess whether the interpretation of the test was affected when both cortisol levels were taken into consideration. Data were obtained by retrospective chart review from a single pediatric endocrinology unit over a 7-year period. We identified 82 patients who completed the LDST. Their mean age was 11.7 years, and 37% were female. Cortisol levels were evaluated at baseline and 30 and 60 minutes after cosyntropin administration. A cutoff value ≥18 μg/dL was used to define adrenal sufficiency. We found that 54% of patients reached peak cortisol levels at 60 minutes, and 11 patients who did not pass the test at 30 minutes did so at 60 minutes. The only predictive characteristic was weight status; overweight and obese individuals tended to peak at 30 minutes, and normal and underweight individuals tended to peak at 60 minutes. Although further studies are necessary to confirm our findings, it appears that measuring cortisol both 30 and 60 minutes following synthetic ACTH administration may be necessary to avoid overdiagnosing AI.