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3 - Comparison of cortisol responses to low dose ACTH stimuli and injection stress
Aysenur Ozderya, Sule Temizkan, Kadriye Aydin
Objective: We performed a placebo-controlled, single-blind, pilot study to compare the efficacy and safety of low dose cosyntropin stimulation test with injection stress in the diagnosis of secondary adrenocortical insufficiency.
Material and Methods: Twenty-five patients (22 F, 3 M) with a low or normal plasma ACTH level, morning plasma cortisol level <15 µg/dL and an indication of cosyntropin stimulation test for secondary adrenocortical insufficiency were included in the study. On the first day, the test was performed with direct intravenous injection with 1 mL 0.9% saline. On the second day at the same time and with the same method, the test was repeated with 1 µg/mL cosyntropin solution. Immediately prior to the procedure, blood samples were taken from the cannula located in the other forearm for measurement of plasma cortisol at 30th and 60th minutes.
Results: The median ACTH value of the patients "ed for the study was 22.10 pg/mL (14.00-29.30) and the mean plasma cortisol level was 6.71±2.00 µg/dL. The baseline plasma cortisol values measured at one minute in the placebo-controlled tests for comparison of injection stress with 1 µg cosyntropin stimulation were similar, but a significant statistically significant difference was found between plasma cortisol values measured at 30th and 60th minutes (p<0.001).
Conclusion: Injection stress, which occurs during intravenous injection, does not cause an increase in cortisol responses. However, 1 µg cosyntropin stimulation test at the physiological doses produces a significant cortisol response, especially at 30 minutes.
Keywords: Adrenal insufficiency, cortisol, injection stress stimuli, low-dose cosyntropin stimulation test
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