High-Dose and Low-Dose Cosyntropin Stimulation Tests for Diagnosis of Adrenal Insufficiency
Authors: Gabriel Dickstein
Journal: Annals of Internal Medicine (2004)

Letters17 February 2004High-Dose and Low-Dose Cosyntropin Stimulation Tests for Diagnosis of Adrenal InsufficiencyGabriel Dickstein, MDGabriel Dickstein, MDFrom Bnai Zion Medical Center; Haifa 31048, Israel.Search for more papers by this authorAuthor, Article, and Disclosure Informationhttps://doi.org/10.7326/0003-4819-140-4-200402170-00026 SectionsAboutFull TextPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissions ShareFacebookTwitterLinkedInRedditEmail TO THE EDITOR:Dorin and colleagues (1) compared the 250-µg and 1-µg cosyntropin stimulation tests for diagnosis of secondary adrenal insufficiency. Using complex statistical methods, they concluded that both tests perform similarly. The authors reported that they searched the MEDLINE database for all relevant English-language papers published between 1966 and 2002. They found 9 papers comparing the 1-µg test with insulin tolerance or metyrapone tests and 7 papers also comparing it with the 250-µg test. Unfortunately, they failed to find on MEDLINE 3 additional studies pointing to an advantage with the 1-µg test.Rose and colleagues (2), in a study ...References1. Dorin RI, Qualls CR, Crapo LM. Diagnosis of adrenal insufficiency. Ann Intern Med. 2003;139:194-204. [PMID: 12899587] LinkGoogle Scholar2. 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 Scholar3. 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 Scholar4. 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 Scholar5. 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 Scholar6. 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 Scholar7. Clark PM, Neylon I, Raggatt PR, Sheppard MC, Stewart PM. Defining the normal cortisol response to the short Synacthen test: implications for the investigation of hypothalamic-pituitary disorders. Clin Endocrinol (Oxf). 1998;49:287-92. [PMID: 9861317] CrossrefMedlineGoogle Scholar Author, Article, and Disclosure InformationAffiliations: From Bnai Zion Medical Center; Haifa 31048, Israel. 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 Richard I. Dorin , Clifford R. Qualls , and Lawrence M. Crapo Metrics Cited ByComparison of total, salivary and calculated free cortisol levels in patients with severe sepsisHyponatraemia in older people as a sign of adrenal insufficiency: a case-control studyA Comparative Effectiveness Analysis of Alternative Strategies to Assess Hypothalamic-Pituitary-Adrenal Axis Function After Microsurgical Resection of Pituitary TumorsAssessment of the hypothalamic–pituitary–adrenal axis in critical illnessDexamethasone suppression test predicts later development of an impaired adrenal function after a 14-day course of prednisone in healthy volunteersUse of morning serum cortisol level after transsphenoidal resection of pituitary adenoma to predict the need for long-term glucocorticoid supplementationAdrenal Function in Children with Asthma and Allergic Rhinitis Treated with Combination of Inhaled and Nasal CorticosteroidsLow-dose and high-dose adrenocorticotropin testing: indications and shortcomingsEvaluation 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 insufficiencyPlasma aldosterone response to the low-dose adrenocorticotrophin (ACTH 1?24) stimulation test 17 February 2004Volume 140, Issue 4Page: 312-313KeywordsArea under the curveCortisolDatabasesInsulinInsulin resistanceNegative predictive valuePositive predictive valueResearch laboratoriesSpecificityStatistical methods ePublished: 17 February 2004 Issue Published: 17 February 2004 CopyrightCopyright © 2004 by American College of Physicians. All Rights Reserved.PDF DownloadLoading ...