Abstract
In primary adrenal insufficiency plasma ACTH values are 5-10 times above the upper normal limit (80-100 pg/ml) and allow a confirmation of the diagnosis even during substitution therapy. Clearly elevated ACTH levels (mean 720 pg/ml) are found in 50% of treated CAH patients. In cushing's disease ACTH concentrations at or above 500 pg/ml of plasma are found. The ACTH-response to a 3 hour metyrapone test was compared between 18 steroid treated patients (29 tests) and 21 tests performed for growth retardation. The tests were analysed based on the following criteria: basal ACTH, < 50-100 pg/ml, increase ≥ 50 pg/ml, maximum ≥ 100 pg/ml. Cortisol basal value 6-13 μg%, compound-S increase ≥ 4 μg%. In steroid treated patients a normal function was found in 4 tests and signs of incomplete recovery in 10 tests. In 6 tests a partial insufficiency was diagnosed. A complete suppression was found in 4 tests. ACTH adrenal function during and after steroid treatment appears to be largely unpredictable. The metyrapone test is valuable in assessing ACTH adrenal function in suspected secondary insufficiences. Plasma ACTH concentrations without stimulation are helpful for the diagnosis of primary adrenal insufficiency of cushing's disease and for the biochemical control of congenital adrenal hyperplasia.
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Girard, J., Baumann, J. & Zuppinger, K. Assessment of ACTH-Adrenal Activity and Diagnostic Value of Plasma ACTH. Pediatr Res 13, 1196 (1979). https://doi.org/10.1203/00006450-197910000-00093
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DOI: https://doi.org/10.1203/00006450-197910000-00093