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Original ArticleOpen Access
Adrenocorticotropin Stimulation Test in Congenital Adrenal Hyperplasia : Comparison Between Standard and Low Dose Test
Panamonta O 
,
Thinkhamrop MB ,
Kirdpon W ,
Pudtawaro L ,
Sungsahachart D
,
Thinkhamrop MB ,
Kirdpon W ,
Pudtawaro L ,
Sungsahachart D BANDIT THINKHAMROP, PhD**,
LA-OR PUDTAWARO, BSc*,
The aim of the study was to compare the response between the standard and low dose
adrenocorticotropin (ACTH) test for patients with congenital adrenal hyperplasia (CAH). The authors
employed a 2-by-2 crossover design and enrolled 16 patients, 14 girls and 2 boys, aged between 1.4
months and 15 years. Steroid treatment was stopped 24 hours before each test was conducted. The
standard ACTH (250 Jlg) test was performed followed by the low dose test ( 1 Jlg) in eight patients; the
other eight underwent the low dose ACTH test first followed by the standard one. The cortisol and 17-
hydroxyprogesterone (17-0HP) levels in each patient varied unpredictably between the two tests. The
cortisol responses to the low dose ACTH at 30 and 60 minutes were lower than at time zero; in con-
trast to the 60-minute peak cortisol response to the standard dose. The serum 17-0HP in all specimens
was more than 10,000 ng/dl (300 nmoi!L), with the peak response at 60 minutes in both groups. Both
the low dose and standard dose ACTH test indicated adrenal insufficiency and the high 17-OHP
levels were diagnostic of 21-hydroxylase (21-0H) deficiency. If the low dose ACTH test becomes the
"standard" ACTH test, the diagnosis of 21-0H deficiency would probably not be missed.
Key word
: Congenital Adrenal Hyperplasia, Low Dose ACTH Test, 21-Hydroxylase Deficiency
LA-OR PUDTAWARO, BSc*,
The aim of the study was to compare the response between the standard and low dose
adrenocorticotropin (ACTH) test for patients with congenital adrenal hyperplasia (CAH). The authors
employed a 2-by-2 crossover design and enrolled 16 patients, 14 girls and 2 boys, aged between 1.4
months and 15 years. Steroid treatment was stopped 24 hours before each test was conducted. The
standard ACTH (250 Jlg) test was performed followed by the low dose test ( 1 Jlg) in eight patients; the
other eight underwent the low dose ACTH test first followed by the standard one. The cortisol and 17-
hydroxyprogesterone (17-0HP) levels in each patient varied unpredictably between the two tests. The
cortisol responses to the low dose ACTH at 30 and 60 minutes were lower than at time zero; in con-
trast to the 60-minute peak cortisol response to the standard dose. The serum 17-0HP in all specimens
was more than 10,000 ng/dl (300 nmoi!L), with the peak response at 60 minutes in both groups. Both
the low dose and standard dose ACTH test indicated adrenal insufficiency and the high 17-OHP
levels were diagnostic of 21-hydroxylase (21-0H) deficiency. If the low dose ACTH test becomes the
"standard" ACTH test, the diagnosis of 21-0H deficiency would probably not be missed.
Key word
: Congenital Adrenal Hyperplasia, Low Dose ACTH Test, 21-Hydroxylase Deficiency
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