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Rajiv B Kumar - One of the best experts on this subject based on the ideXlab platform.
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salivary cortisol levels by tandem mass spectrometry during high dose ACTH Stimulation Test for adrenal insufficiency in children
Endocrine, 2020Co-Authors: Christina S Chao, Rajiv B KumarAbstract: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.
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Salivary cortisol levels by tandem mass spectrometry during high dose ACTH Stimulation Test for adrenal insufficiency in children
Endocrine, 2020Co-Authors: Christina S Chao, Rajiv B KumarAbstract: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
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Salivary cortisol levels by tandem mass spectrometry during high dose ACTH Stimulation Test for adrenal insufficiency in children.
Endocrine, 2019Co-Authors: Christina S Chao, Rajiv B KumarAbstract: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 - One of the best experts on this subject based on the ideXlab platform.
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salivary cortisol levels by tandem mass spectrometry during high dose ACTH Stimulation Test for adrenal insufficiency in children
Endocrine, 2020Co-Authors: Christina S Chao, Rajiv B KumarAbstract: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.
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Salivary cortisol levels by tandem mass spectrometry during high dose ACTH Stimulation Test for adrenal insufficiency in children
Endocrine, 2020Co-Authors: Christina S Chao, Rajiv B KumarAbstract: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
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Salivary cortisol levels by tandem mass spectrometry during high dose ACTH Stimulation Test for adrenal insufficiency in children.
Endocrine, 2019Co-Authors: Christina S Chao, Rajiv B KumarAbstract: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 - One of the best experts on this subject based on the ideXlab platform.
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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, 1997Co-Authors: J J Mukherjee, Jacome J De Castro, Gregory Kaltsas, F Afshar, A Grossman, J A H Wass, G M BesserAbstract: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.
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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, 1997Co-Authors: J J Mukherjee, Jacome J De Castro, Gregory Kaltsas, F Afshar, J A H Wass, Ashley B. Grossman, G M BesserAbstract: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.
Michelle H Barton - One of the best experts on this subject based on the ideXlab platform.
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hypothalamic pituitary adrenal axis assessment in healthy term neonatal foals utilizing a paired low dose high dose ACTH Stimulation Test
Journal of Veterinary Internal Medicine, 2009Co-Authors: Kelsey A Hart, G L Heusner, Natalie Norton, Michelle H BartonAbstract:Background: Hypothalamic-pituitary-adrenal (HPA) axis function is dynamic in the neonatal foal. The paired low dose/high dose cosyntropin (ACTH) Stimulation Test allows comprehensive HPA axis assessment, but has not been evaluated in neonatal foals. Hypothesis: Foal age will significantly affect cortisol responses to a paired 10 and 100 μg dose cosyntropin Stimulation Test in healthy neonatal foals. Animals: Twenty healthy neonatal foals. Methods: HPA axis function was assessed in 12 foals at birth and at 12–24, 36–48 hours, and 5–7 days of age. At each age, basal cortisol and ACTH concentrations were measured and cortisol responses to 10 and 100 μg cosyntropin were assessed with a paired ACTH Stimulation Test protocol. Eight additional 36–48-hour-old foals received saline instead of 10 μg cosyntropin in the same-paired ACTH Stimulation Test design. Results: At birth, foals had significantly higher basal cortisol and ACTH concentrations and higher basal ACTH : cortisol ratios compared with foals in all other age groups. A significant cortisol response to both the 10 and 100 μg doses of cosyntropin was observed in all foals. The magnitude of the cortisol response to both doses of cosyntropin was significantly different across age groups, with the most marked responses in younger foals. There was no effect of the paired ACTH Stimulation Test design itself on cortisol responses. Conclusions and Clinical Importance: A paired 10 and 100 μg cosyntropin Stimulation Test can be used to evaluate HPA axis function in neonatal foals. Consideration of foal age is important in interpretation of HPA axis assessment.
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Hypothalamic-pituitary-adrenal axis assessment in healthy term neonatal foals utilizing a paired low dose/high dose ACTH Stimulation Test.
Journal of Veterinary Internal Medicine, 2008Co-Authors: Kelsey A Hart, G L Heusner, Natalie Norton, Michelle H BartonAbstract:Background: Hypothalamic-pituitary-adrenal (HPA) axis function is dynamic in the neonatal foal. The paired low dose/high dose cosyntropin (ACTH) Stimulation Test allows comprehensive HPA axis assessment, but has not been evaluated in neonatal foals. Hypothesis: Foal age will significantly affect cortisol responses to a paired 10 and 100 μg dose cosyntropin Stimulation Test in healthy neonatal foals. Animals: Twenty healthy neonatal foals. Methods: HPA axis function was assessed in 12 foals at birth and at 12–24, 36–48 hours, and 5–7 days of age. At each age, basal cortisol and ACTH concentrations were measured and cortisol responses to 10 and 100 μg cosyntropin were assessed with a paired ACTH Stimulation Test protocol. Eight additional 36–48-hour-old foals received saline instead of 10 μg cosyntropin in the same-paired ACTH Stimulation Test design. Results: At birth, foals had significantly higher basal cortisol and ACTH concentrations and higher basal ACTH : cortisol ratios compared with foals in all other age groups. A significant cortisol response to both the 10 and 100 μg doses of cosyntropin was observed in all foals. The magnitude of the cortisol response to both doses of cosyntropin was significantly different across age groups, with the most marked responses in younger foals. There was no effect of the paired ACTH Stimulation Test design itself on cortisol responses. Conclusions and Clinical Importance: A paired 10 and 100 μg cosyntropin Stimulation Test can be used to evaluate HPA axis function in neonatal foals. Consideration of foal age is important in interpretation of HPA axis assessment.
Kyung Soo Park - One of the best experts on this subject based on the ideXlab platform.
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diagnostic value of 1microgram rapid ACTH Stimulation Test according to the timing of sampling of serum cortisol in patients with suspected central adrenal insufficiency
Endocrinology and Metabolism, 2004Co-Authors: Do Joon Park, Chan Soo Shin, Kyung Soo ParkAbstract:Background: Traditional Testing of the hypothalamic-pituitary-adrenal axis function has essentially relied upon the insulin tolerance Test or the metyrapone Test (both Tests are not only uncomfortable, but are also dangerous). The standard ACTH Stimulation Test uses an extremely supra-physiologic amount (250 ) of ACTH to evaluate a physiological response, which may result in a false normal response. The 1 rapid ACTH Stimulation Test is more physiological and more sensitive than the standard Test, but there exist much controversy about when the serum cortisol should be measured or what the most appropriate cut-off point is for normality or whether the 1 ACTH commercial solution is needed. The aims of this study were to investigate 1) whether 1 of ACTH is an appropriate amount to stimulate the adrenal gland of patients that have suspected central adrenal insufficiency compared with insulin tolerance Test (ITT) and 2) the diagnostic value of the 1 rapid ACTH Stimulation Test according to timing of sampling of serum cortisol. Methods: In order to evaluate the dose-response relationship between ACTH and cortisol, we performed the ITT in 77 patients with suspected central adrenal insufficiency with serial measurements of serum cortisol and plasma ACTH. We drew the blood samples in 10 min intervals between 10 and 60 min after the administration of 1 ACTH in 39 patients with central adrenal insufficiency and in 38 pituitary control patients with pituitary. ITT was used to confirm the diseases for the patients of central adrenal insufficiency, but for pituitary control patients, the ITT indicated normality in the patients. Also, all subjects underwent the 250 rapid ACTH Stimulation Test, and we compared the diagnostic value of the 1 ACTH Stimulation Test with the 250 Test. Results: 1) The plasma ACTH level after the 1 ACTH Stimulation Test, even if it was be assumed as approximately 300 pg/mL, was expected to be sufficient enough to stimulate the adrenal cortex normally (serum cortisol levels >18 /dL) compared to the plasma ACTH level in the ITT. 2) The sensitivity and specificity of the 1 rapid ACTH Stimulation Test was highest with 92.3% and 84.2%, respectively, when serum cortisol levels were measured at 20, 30, and 40 min after the ACTH injection. The 1 rapid ACTH Stimulation Test was more sensitive than the 250 ACTH Test (sensitivity: 92.3%, specificity: 71.8%). Conclusion: The 1 rapid ACTH Stimulation Test was more sensitive Test in patients with suspected central adrenal insufficiency, and blood samples for cortisol levels should be drawn at 20, 30, and 40 min after ACTH administration.
