Mifepristone Dynamic Testing for Diagnosis for Central Adrenal Insufficiency

Study Overview
=================
Brief Summary
-----------------
The researchers propose the use of mifepristone as an alternative way to test for Central Adrenal Insufficiency (CAI). They want to assess the feasibility of recruitment and the efficacy of the purposed method.

Detailed Description
-----------------
Recruitment for this trial was legally opened on February 17, 2020. When the record was first released, it incorrectly listed the recruitment status as Not Yet Recruiting. This mistake was noticed before the first participant actually enrolled, May 5, 2021. The decision to terminate for low recruitment was made on Sept 7, 2022, approximately 30 months later, as at that point it was deemed impossible to reach the initial enrollment target of 26.

Official Title
-----------------
Mifepristone Dynamic Testing for Diagnosis for Central Adrenal Insufficiency

Conditions
-----------------
Central Adrenal Insufficiency, Mifepristone

Intervention / Treatment
-----------------
* Drug: Mifepristone


Participation Criteria
=================
Eligibility Criteria
-----------------
Inclusion Criteria (1 of the following): Completed insulin tolerance testing (ITT) at University of Michigan from 2012 to present. Are scheduled to complete ITT. Are clinically suspected to have adrenal insufficiency but have not undergone ITT. Exclusion Criteria: Female patients who are of child-bearing potential (defined as a sexually mature woman who has not undergone hysterectomy, bilateral oophorectomy bilateral salpingectomy or bilateral tubal ligation/occlusion, at least 12 weeks prior to screening, or who has not been naturally postmenopausal for at least 24 consecutive months prior to study enrollment) and not using non-hormonal contraception. Female patients not willing to use non-hormonal contraception for one month following treatment. Women who are pregnant or breast feeding. Patients with an existing diagnosis of adrenal insufficiency who are on any glucocorticoid replacement other than oral hydrocortisone or prednisone. Patients on medications that are strong CYP3A Patients taking other medications metabolized by CYP3A Patients who have a history of QT prolongation and patients with any recent abnormal electrocardiogram (ECG).

Ages Eligible for Study
-----------------
Minimum Age: 18 Years

Sexes Eligible for Study
-----------------
All

Accepts Healthy Volunteers
-----------------
No

Study Plan
=================
How is the study designed?
-----------------

Design Details

Primary Purpose: Diagnostic
Intervention Model: Single Group Assignment
Masking: None (Open Label)


Arms and Interventions

| Participant Group/Arm | Intervention/Treatment |
| --- | --- |
| Experimental: Mifepristone<br>Patients will be provided a single dose of 600 milligram (mg) mifepristone to be administered orally, and subjects will be instructed to take the drug between 10PM and 11PM on Day 1. | Drug: Mifepristone<br>* Mifepristone is a selective antagonist of the progesterone receptor at low doses and blocks the glucocorticoid receptor (GR-II) at higher doses. Mifepristone has high affinity for the GR-II receptor but little affinity for the GR-I (MR, mineralocorticoid) receptor.<br>* Other names: KORLYM®, C1073, RU486;|

What is the study measuring?
-----------------
Primary Outcome Measures

| Outcome Measure | Measure Description | Time Frame |
| --- | --- | --- |
| Number of Study Participants Recruited | Because this was a feasibility trial, the goal was to see how many participants could be successfully recruited. The original intent was for the recruitment period to be for 36 months, with a target enrollment of 26 participants. The trial opened for recruitment on February 17, 2020. Because of low enrollment, the decision to terminate was made on September 7, 2022, approximately 30 months later. | Up to 88 days | 
| Number of Study Participants With Complete Study Data Captured | Because this was a feasibility trial, the goal was to see how many participants could be successfully recruited. The original intent was for the recruitment period to be for 36 months, with a target enrollment of 26 participants. Because of low enrollment, the decision to terminate was made after the trial had been open for recruitment for approximately 30 months (February 17, 2020 - September 7, 2022). | 30 days | 

Secondary Outcome Measures

| Outcome Measure | Measure Description | Time Frame |
| --- | --- | --- |
| Peak Cortisol Measured After Mifepristone | Serum cortisol was collected the day after mifepristone administration and insulin tolerance test insulin tolerance test (ITT). | Day 2 (day after mifepristone administration) | 
| Absolute ACTH After Mifepristone | ACTH level 8:00 am (Day 2) following administration of mifepristone the night before at 10:00 pm. | Day 2 (day after mifepristone administration) | 

 Terms related to the study
=================
Keywords Provided by Centre Hospitalier Valida
-----------------
Insulin Tolerance Test