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ACTH Stimulation Test

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Rajiv B Kumar – 1st expert on this subject based on the ideXlab platform

  • salivary cortisol levels by tandem mass spectrometry during high dose ACTH Stimulation Test for adrenal insufficiency in children
    Endocrine, 2020
    Co-Authors: Christina S Chao, Rajiv B Kumar

    Abstract:

    Serum cortisol measurements after ACTH Stimulation are currently used to evaluate for adrenal insufficiency in children. We aim to determine if salivary cortisol measured by liquid chromatography–tandem mass spectrometry (LC–MS/MS) can confirm or replace serum cortisol during high dose ACTH Stimulation Test to improve Test compliance and interpretation. We also aim to gain preliminary understanding of normal ranges of salivary cortisol in normal children at am, bedtime, and midnight. Children aged 6–17 years meeting study criteria and Tested for adrenal insufficiency were recruited to concomitantly collect saliva and serum samples during high dose ACTH Stimulation Test. Normal children aged 3–18 years were recruited to collect morning, bedtime, and midnight saliva samples. Salivary cortisol was measured using LC–MS/MS while serum cortisol was determined by an immunoassay. Salivary cortisol in normal children were higher at am and lower at bedtime and midnight (p value <0.0002 and <0.007, respectively). The midnight and bedtime levels were not sufficiently different (p value 0.36). Salivary cortisol during ACTH Stimulation Test positively and closely correlated with serum cortisol with 100% specificity and sensitivity when 18 µg/dL for serum and 500 ng/dL for salivary cortisol were used as cutoff values respectively for adrenal sufficiency. Measurement of salivary cortisol by LC–MS/MS is less invasive, more convenient and better time controlled in busy pediatric clinic, therefore is better suited for young children to be used during high dose ACTH Stimulation Test to evaluate for adrenal insufficiency and to assist interpretation of Test results by serum cortisol.

  • Salivary cortisol levels by tandem mass spectrometry during high dose ACTH Stimulation Test for adrenal insufficiency in children
    Endocrine, 2020
    Co-Authors: Christina S Chao, Rajiv B Kumar

    Abstract:

    Purpose Serum cortisol measurements after ACTH Stimulation are currently used to evaluate for adrenal insufficiency in children. We aim to determine if salivary cortisol measured by liquid chromatography–tandem mass spectrometry (LC–MS/MS) can confirm or replace serum cortisol during high dose ACTH Stimulation Test to improve Test compliance and interpretation. We also aim to gain preliminary understanding of normal ranges of salivary cortisol in normal children at am, bedtime, and midnight. Methods Children aged 6–17 years meeting study criteria and Tested for adrenal insufficiency were recruited to concomitantly collect saliva and serum samples during high dose ACTH Stimulation Test. Normal children aged 3–18 years were recruited to collect morning, bedtime, and midnight saliva samples. Salivary cortisol was measured using LC–MS/MS while serum cortisol was determined by an immunoassay. Results Salivary cortisol in normal children were higher at am and lower at bedtime and midnight ( p value

  • Salivary cortisol levels by tandem mass spectrometry during high dose ACTH Stimulation Test for adrenal insufficiency in children.
    Endocrine, 2019
    Co-Authors: Christina S Chao, Rajiv B Kumar

    Abstract:

    Serum cortisol measurements after ACTH Stimulation are currently used to evaluate for adrenal insufficiency in children. We aim to determine if salivary cortisol measured by liquid chromatography–tandem mass spectrometry (LC–MS/MS) can confirm or replace serum cortisol during high dose ACTH Stimulation Test to improve Test compliance and interpretation. We also aim to gain preliminary understanding of normal ranges of salivary cortisol in normal children at am, bedtime, and midnight. Children aged 6–17 years meeting study criteria and Tested for adrenal insufficiency were recruited to concomitantly collect saliva and serum samples during high dose ACTH Stimulation Test. Normal children aged 3–18 years were recruited to collect morning, bedtime, and midnight saliva samples. Salivary cortisol was measured using LC–MS/MS while serum cortisol was determined by an immunoassay. Salivary cortisol in normal children were higher at am and lower at bedtime and midnight (p value

Christina S Chao – 2nd expert on this subject based on the ideXlab platform

  • salivary cortisol levels by tandem mass spectrometry during high dose ACTH Stimulation Test for adrenal insufficiency in children
    Endocrine, 2020
    Co-Authors: Christina S Chao, Rajiv B Kumar

    Abstract:

    Serum cortisol measurements after ACTH Stimulation are currently used to evaluate for adrenal insufficiency in children. We aim to determine if salivary cortisol measured by liquid chromatography–tandem mass spectrometry (LC–MS/MS) can confirm or replace serum cortisol during high dose ACTH Stimulation Test to improve Test compliance and interpretation. We also aim to gain preliminary understanding of normal ranges of salivary cortisol in normal children at am, bedtime, and midnight. Children aged 6–17 years meeting study criteria and Tested for adrenal insufficiency were recruited to concomitantly collect saliva and serum samples during high dose ACTH Stimulation Test. Normal children aged 3–18 years were recruited to collect morning, bedtime, and midnight saliva samples. Salivary cortisol was measured using LC–MS/MS while serum cortisol was determined by an immunoassay. Salivary cortisol in normal children were higher at am and lower at bedtime and midnight (p value <0.0002 and <0.007, respectively). The midnight and bedtime levels were not sufficiently different (p value 0.36). Salivary cortisol during ACTH Stimulation Test positively and closely correlated with serum cortisol with 100% specificity and sensitivity when 18 µg/dL for serum and 500 ng/dL for salivary cortisol were used as cutoff values respectively for adrenal sufficiency. Measurement of salivary cortisol by LC–MS/MS is less invasive, more convenient and better time controlled in busy pediatric clinic, therefore is better suited for young children to be used during high dose ACTH Stimulation Test to evaluate for adrenal insufficiency and to assist interpretation of Test results by serum cortisol.

  • Salivary cortisol levels by tandem mass spectrometry during high dose ACTH Stimulation Test for adrenal insufficiency in children
    Endocrine, 2020
    Co-Authors: Christina S Chao, Rajiv B Kumar

    Abstract:

    Purpose Serum cortisol measurements after ACTH Stimulation are currently used to evaluate for adrenal insufficiency in children. We aim to determine if salivary cortisol measured by liquid chromatography–tandem mass spectrometry (LC–MS/MS) can confirm or replace serum cortisol during high dose ACTH Stimulation Test to improve Test compliance and interpretation. We also aim to gain preliminary understanding of normal ranges of salivary cortisol in normal children at am, bedtime, and midnight. Methods Children aged 6–17 years meeting study criteria and Tested for adrenal insufficiency were recruited to concomitantly collect saliva and serum samples during high dose ACTH Stimulation Test. Normal children aged 3–18 years were recruited to collect morning, bedtime, and midnight saliva samples. Salivary cortisol was measured using LC–MS/MS while serum cortisol was determined by an immunoassay. Results Salivary cortisol in normal children were higher at am and lower at bedtime and midnight ( p value

  • Salivary cortisol levels by tandem mass spectrometry during high dose ACTH Stimulation Test for adrenal insufficiency in children.
    Endocrine, 2019
    Co-Authors: Christina S Chao, Rajiv B Kumar

    Abstract:

    Serum cortisol measurements after ACTH Stimulation are currently used to evaluate for adrenal insufficiency in children. We aim to determine if salivary cortisol measured by liquid chromatography–tandem mass spectrometry (LC–MS/MS) can confirm or replace serum cortisol during high dose ACTH Stimulation Test to improve Test compliance and interpretation. We also aim to gain preliminary understanding of normal ranges of salivary cortisol in normal children at am, bedtime, and midnight. Children aged 6–17 years meeting study criteria and Tested for adrenal insufficiency were recruited to concomitantly collect saliva and serum samples during high dose ACTH Stimulation Test. Normal children aged 3–18 years were recruited to collect morning, bedtime, and midnight saliva samples. Salivary cortisol was measured using LC–MS/MS while serum cortisol was determined by an immunoassay. Salivary cortisol in normal children were higher at am and lower at bedtime and midnight (p value

G M Besser – 3rd expert on this subject based on the ideXlab platform

  • a comparison of the insulin tolerance glucagon Test with the short ACTH Stimulation Test in the assessment of the hypothalamo pituitary adrenal axis in the early post operative period after hypophysectomy
    Clinical Endocrinology, 1997
    Co-Authors: J J Mukherjee, Jacome J De Castro, Gregory Kaltsas, F Afshar, A Grossman, J A H Wass, G M Besser

    Abstract:

    OBJECTIVE: The insulin tolerance Test (ITT) is the established reference Test for assessing the hypothalamo-pituitary-adrenal (HPA) axis. Various authorities, however, have suggested that the 250 microgram short ACTH Stimulation Test may be used to assess the HPA axis in place of the ITT in suspected hypopituitarism, although a number of other studies have suggested that the Test may be unreliable in this setting. In this study, the ITT (or glucagon Test) has been compared with the 250 microgram short ACTH Stimulation Test in patients with pituitary tumours pre-operatively and within 2 weeks of trans-sphenoidal hypophysectomy. DESIGN: An ITT, or a glucagon Test when the ITT was contraindicated, and the 250 micrograms short ACTH Stimulation Test, were performed in all the patients before (an ITT in 18 and a glucagon Test in three patients) and within 2 weeks after trans-sphenoidal hypophysectomy (an ITT in 16 and a glucagon Test in five patients). PATIENTS: Twenty-one patients with pituitary disorders (15 with acromegaly, one with a prolactinoma and five with non-functioning tumours) were studied; four had a microadenoma, two a mesoadenoma and 15 a macroadenoma. MEASUREMENTS: Serum cortisol was measured by radioimmunoassay. A normal response was defined as a rise in serum cortisol to 580 nmol/l or above for all the Tests. RESULTS: Before surgery, three of 18 patients (17%) had a discrepancy between the ITT and the 30 minute short ACTH Stimulation Test and one of three between the glucagon Test and the 30 minute short ACTH Stimulation Test. Combined together, pre-operatively, four of 21 patients (19%) had discrepant results. In the early post-operative period, the discrepancy between ITT and the 30 minute short ACTH Stimulation Test was higher with four of 16 patients (25%) showing discordant results; one of the five patients Tested had a discrepancy between the glucagon Test and the 30 minute short ACTH Stimulation Test. On combining the Tests, the post-operative discrepancy was five of 21 patients (24%). CONCLUSIONS: The 250 microgram short ACTH Stimulation Test produces discordant results from the ITT in a clinically significant proportion of affected patients when assessing the HPA axis, although the rate of discordance varies according to the criteria used for normality for both the Tests. We suggest that the ITT should remain the preferred Test for assessing ACTH secretory capacity compared with the standard 250 microgram short ACTH Stimulation Test, both in the preoperative and in the early post-trans-sphenoidal hypophysectomy period.

  • A comparison of the insulin tolerance/glucagon Test with the short ACTH Stimulation Test in the assessment of the hypothalamo-pituitary-adrenal axis in the early post-operative period after hypophysectomy.
    Clinical Endocrinology, 1997
    Co-Authors: J J Mukherjee, Jacome J De Castro, Gregory Kaltsas, F Afshar, J A H Wass, Ashley B. Grossman, G M Besser

    Abstract:

    OBJECTIVE: The insulin tolerance Test (ITT) is the established reference Test for assessing the hypothalamo-pituitary-adrenal (HPA) axis. Various authorities, however, have suggested that the 250 microgram short ACTH Stimulation Test may be used to assess the HPA axis in place of the ITT in suspected hypopituitarism, although a number of other studies have suggested that the Test may be unreliable in this setting. In this study, the ITT (or glucagon Test) has been compared with the 250 microgram short ACTH Stimulation Test in patients with pituitary tumours pre-operatively and within 2 weeks of trans-sphenoidal hypophysectomy. DESIGN: An ITT, or a glucagon Test when the ITT was contraindicated, and the 250 micrograms short ACTH Stimulation Test, were performed in all the patients before (an ITT in 18 and a glucagon Test in three patients) and within 2 weeks after trans-sphenoidal hypophysectomy (an ITT in 16 and a glucagon Test in five patients). PATIENTS: Twenty-one patients with pituitary disorders (15 with acromegaly, one with a prolactinoma and five with non-functioning tumours) were studied; four had a microadenoma, two a mesoadenoma and 15 a macroadenoma. MEASUREMENTS: Serum cortisol was measured by radioimmunoassay. A normal response was defined as a rise in serum cortisol to 580 nmol/l or above for all the Tests. RESULTS: Before surgery, three of 18 patients (17%) had a discrepancy between the ITT and the 30 minute short ACTH Stimulation Test and one of three between the glucagon Test and the 30 minute short ACTH Stimulation Test. Combined together, pre-operatively, four of 21 patients (19%) had discrepant results. In the early post-operative period, the discrepancy between ITT and the 30 minute short ACTH Stimulation Test was higher with four of 16 patients (25%) showing discordant results; one of the five patients Tested had a discrepancy between the glucagon Test and the 30 minute short ACTH Stimulation Test. On combining the Tests, the post-operative discrepancy was five of 21 patients (24%). CONCLUSIONS: The 250 microgram short ACTH Stimulation Test produces discordant results from the ITT in a clinically significant proportion of affected patients when assessing the HPA axis, although the rate of discordance varies according to the criteria used for normality for both the Tests. We suggest that the ITT should remain the preferred Test for assessing ACTH secretory capacity compared with the standard 250 microgram short ACTH Stimulation Test, both in the preoperative and in the early post-trans-sphenoidal hypophysectomy period.