High-Dose and Low-Dose Cosyntropin Stimulation Tests for Diagnosis of Adrenal Insufficiency
Authors: Richard I. Dorin, Clifford R. Qualls, Lawrence M. Crapo
Journal: Annals of Internal Medicine (2004)

Letters17 February 2004High-Dose and Low-Dose Cosyntropin Stimulation Tests for Diagnosis of Adrenal InsufficiencyRichard I. Dorin, MD, Clifford R. Qualls, PhD, and Lawrence M. Crapo, MD, PhDRichard I. Dorin, MDFrom New Mexico Veterans Affairs Healthcare System and University of New Mexico School of Medicine, Albuquerque, NM 87108; and Santa Clara Valley Medical Center, San Jose, CA 95128.Search for more papers by this author, Clifford R. Qualls, PhDFrom New Mexico Veterans Affairs Healthcare System and University of New Mexico School of Medicine, Albuquerque, NM 87108; and Santa Clara Valley Medical Center, San Jose, CA 95128.Search for more papers by this author, and Lawrence M. Crapo, MD, PhDFrom New Mexico Veterans Affairs Healthcare System and University of New Mexico School of Medicine, Albuquerque, NM 87108; and Santa Clara Valley Medical Center, San Jose, CA 95128.Search for more papers by this authorAuthor, Article, and Disclosure Informationhttps://doi.org/10.7326/0003-4819-140-4-200402170-00027 SectionsAboutFull TextPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissions ShareFacebookTwitterLinkedInRedditEmail IN RESPONSE:The paper by Gandhi and associates (1) was excluded from our analysis because of inadequate stratification of patients by gold standard testing (only 7 of 31 patients had an insulin tolerance or metyrapone test). The paper by Choi and coworkers (2) appeared on MEDLINE in April 2003, after our final draft was submitted, and includes 72 patients who underwent the 1-µg test and the insulin tolerance test. The paper by Rose and colleagues (3) was not detected by our MEDLINE search and includes 2 separate samples of pediatric patients: 38 who had 250-µg testing and metyrapone testing and ...References1. Gandhi PG, Shah NS, Khandelwal AG, Chauhan P, Menon PS. Evaluation of low dose ACTH stimulation test in suspected secondary adrenocortical insufficiency. J Postgrad Med. 2002;48:280-2. [PMID: 12571383] MedlineGoogle Scholar2. Choi CH, Tiu SC, Shek CC, Choi KL, Chan FK, Kong PS. Use of the low-dose corticotropin stimulation test for the diagnosis of secondary adrenocortical insufficiency. Hong Kong Med J. 2002;8:427-34. [PMID: 12459599] MedlineGoogle Scholar3. Rose SR, Lustig RH, Burstein S, Pitukcheewanont P, Broome DC, Burghen GA. Diagnosis of ACTH deficiency. Comparison of overnight metyrapone test to either low-dose or high-dose ACTH test. Horm Res. 1999;52:73-9. [PMID: 10681636] MedlineGoogle Scholar4. Abdu TA, Elhadd TA, Neary R, Clayton RN. Comparison of the low dose short synacthen test (1 µg), the conventional dose short synacthen test (250 µg), and the insulin tolerance test for assessment of the hypothalamo-pituitary-adrenal axis in patients with pituitary disease. J Clin Endocrinol Metab. 1999;84:838-43. [PMID: 10084558] MedlineGoogle Scholar5. Mayenknecht J, Diederich S, Bahr V, Plockinger U, Oelkers W. Comparison of low and high dose corticotropin stimulation tests in patients with pituitary disease. J Clin Endocrinol Metab. 1998;83:1558-62. [PMID: 9589655] CrossrefMedlineGoogle Scholar Author, Article, and Disclosure InformationAffiliations: From New Mexico Veterans Affairs Healthcare System and University of New Mexico School of Medicine, Albuquerque, NM 87108; and Santa Clara Valley Medical Center, San Jose, CA 95128. PreviousarticleNextarticle Advertisement FiguresReferencesRelatedDetailsSee AlsoDiagnosis of Adrenal Insufficiency Richard I. Dorin , Clifford R. Qualls , and Lawrence M. Crapo High-Dose and Low-Dose Cosyntropin Stimulation Tests for Diagnosis of Adrenal Insufficiency Gabriel Dickstein Metrics Cited ByImmediate postoperative cortisol levels accurately predict postoperative hypothalamic–pituitary–adrenal axis function after transsphenoidal surgery for pituitary tumorsEvaluation of adrenal function using the human corticotrophin-releasing hormone test, low dose Synacthen test and 9am cortisol level in children and adolescents with central adrenal insufficiency 17 February 2004Volume 140, Issue 4Page: 313-314KeywordsAlgorithmsArea under the curveCortisolInsulinInsulin resistanceLikelihood ratioPatientsReceiver operating characteristic curveSpecificity ePublished: 17 February 2004 Issue Published: 17 February 2004 CopyrightCopyright © 2004 by American College of Physicians. All Rights Reserved.PDF DownloadLoading ...