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Amir H Hamrahian - One of the best experts on this subject based on the ideXlab platform.
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Total and free cortisol levels during 1 μg, 25 μg, and 250 μg Cosyntropin stimulation tests compared to insulin tolerance test: results of a randomized, prospective, pilot study
Endocrine, 2017Co-Authors: Seenia Peechakara, James Bena, Nigel J. Clarke, Michael J. Mcphaul, Richard E. Reitz, Robert J. Weil, Pablo Recinos, Laurence Kennedy, Amir H HamrahianAbstract:Purpose The appropriate Cosyntropin dose during Cosyntropin stimulation tests remains uncertain. We conducted a prospective, randomized pilot study to compare 1 μg IV low dose Cosyntropin test, 25 μg IM medium dose Cosyntropin test, and 250 μg IM standard dose Cosyntropin test to evaluate secondary adrenal insufficiency. Insulin tolerance test was used as the gold standard. Method The study included patients with hypothalamic/pituitary disease ( n = 10) with at least one pituitary axis deficiency other than ACTH deficiency and controls ( n = 12). All tests were done in random order. Sensitivity and specificity were calculated for total cortisol and serum free cortisol cut-off levels during Cosyntropin stimulation tests. Results The median (range) age and F/M sex ratios for patients and controls were 54 years (23–62), 2/8, and 33 years (21–51), 6/6, respectively. The best total cortisol cut-off during low dose Cosyntropin test, medium dose Cosyntropin test, 30 min and 60 min standard dose Cosyntropin test were 14.6 μg/dL (100% sensitivity & specificity), 18.7 μg/dL (100% sensitivity, 88% specificity), 16.1 (100% sensitivity & specificity), and 19.5 μg/dL (100% sensitivity & specificity), respectively. There was no difference in the ROC curve for cortisol values between the Cosyntropin stimulation tests ( p > 0.41). Using a cortisol cut-off of 18 μg/dL during Cosyntropin stimulation tests, only cortisol level at 30 min during standard dose Cosyntropin test provided discrimination similar to insulin tolerance test. The best peak free cortisol cut-off levels were 1 μg/dL for insulin tolerance test, 0.9 μg/dL for low dose Cosyntropin test, 0.9 μg/dL for medium dose Cosyntropin test, and 0.9 μg/dL and 1.3 μg/dL for 30 min and 60 min standard dose Cosyntropin test, respectively. Conclusion All Cosyntropin stimulation tests had excellent correlations with insulin tolerance test, when appropriate cut-offs were used. This pilot study does not suggest an advantage in using 25 μg Cosyntropin dose during the Cosyntropin stimulation test. A serum free cortisol cut-off of 0.9 μg/dL may be used as pass criterion during low dose Cosyntropin test, standard dose Cosyntropin test Cosyntropin test, and 30 min standard dose Cosyntropin test.
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total and free cortisol levels during 1 μg 25 μg and 250 μg Cosyntropin stimulation tests compared to insulin tolerance test results of a randomized prospective pilot study
Endocrine, 2017Co-Authors: Seenia Peechakara, James Bena, Nigel J. Clarke, Michael J. Mcphaul, Richard E. Reitz, Robert J. Weil, Pablo Recinos, Laurence Kennedy, Amir H HamrahianAbstract:Purpose The appropriate Cosyntropin dose during Cosyntropin stimulation tests remains uncertain. We conducted a prospective, randomized pilot study to compare 1 μg IV low dose Cosyntropin test, 25 μg IM medium dose Cosyntropin test, and 250 μg IM standard dose Cosyntropin test to evaluate secondary adrenal insufficiency. Insulin tolerance test was used as the gold standard.
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measurements of serum free cortisol in critically ill patients
The New England Journal of Medicine, 2004Co-Authors: Amir H Hamrahian, Tawakalitu S Oseni, Baha M ArafahAbstract:background Because more than 90 percent of circulating cortisol in human serum is protein-bound, changes in the binding proteins can alter measured serum total cortisol concentrations without influencing free concentrations of this hormone. We investigated the effect of decreased amounts of cortisol-binding proteins on serum total and free cortisol concentrations during critical illness, when glucocorticoid secretion is maximally stimulated. methods Base-line serum total cortisol, Cosyntropin-stimulated serum total cortisol, aldosterone, and free cortisol concentrations were measured in 66 critically ill patients and 33 healthy volunteers in groups that were similar with regard to sex and age. Of the 66 patients, 36 had hypoproteinemia (albumin concentration, 2.5 g per deciliter or less), and 30 had near-normal serum albumin concentrations (above 2.5 g per deciliter). results Base-line and Cosyntropin-stimulated serum total cortisol concentrations were lower in the patients with hypoproteinemia than in those with near-normal serum albumin concentrations (P<0.001). However, the mean (±SD) base-line serum free cortisol concentrations were similar in the two groups of patients (5.1±4.1 and 5.2±3.5 µg per deciliter [140.7±113.1 and 143.5±96.6 nmol per liter]) and were several times higher than the values in controls (0.6±0.3 µg per deciliter [16.6±8.3 nmol per liter], P<0.001 for both comparisons). Cosyntropin-stimulated serum total cortisol concentrations were subnormal (18.5 µg per deciliter [510.4 nmol per liter] or less) in 14 of the patients, all of whom had hypoproteinemia. In all 66 patients, including these 14 who had hypoproteinemia, the base-line and Cosyntropin-stimulated serum free cortisol concentrations were high-normal or elevated. conclusions During critical illness, glucocorticoid secretion markedly increases, but the increase is not discernible when only the serum total cortisol concentration is measured. In this study, nearly 40 percent of critically ill patients with hypoproteinemia had subnormal serum total cortisol concentrations, even though their adrenal function was normal. Measuring serum free cortisol concentrations in critically ill patients with hypoproteinemia may help prevent the unnecessary use of glucocorticoid therapy.
Carmela Shechner - One of the best experts on this subject based on the ideXlab platform.
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Performance of low-dose Cosyntropin stimulation test handled via plastic tube
Endocrine, 2017Co-Authors: Leonard Saiegh, Maria Reut, Nizar Jiries, Asala Abu-ahmad, Mohammad Sheikh-ahmad, Limor Chen-konak, Carmela ShechnerAbstract:Purpose Studies on 1 μg low-dose test showed that among 1 μg Cosyntropin samples pushed through long IV plastic tubing, some adrenocorticotropic hormone dosage was not recovered, and in healthy volunteers it provided subnormal cortisol responses. The aim of the current study is to assess whether there is any loss in adrenocorticotropic hormone 1–24 concentration when pushed through a short plastic tube, and to assess serum and salivary cortisol responses in low-dose test among healthy volunteers, using a similar short plastic tube vs. direct intravenous consyntropin injection. Methods We evaluated in vitro if adrenocorticotropic hormone was absorbed in a 2.5 cm plastic tube by measuring adrenocorticotropic hormone 1–24 concentration in a 1 μg/ml adrenocorticotropic hormone aliquot solution before and after being flushed through the plastic tube. For the in vivo study, we recruited 20 healthy adult volunteers. Each subject underwent low-dose test via 2.5 cm plastic tube via plastic tube and via direct intravenous injection by a metal syringe via direct intravenous injection, and cortisol responses were determined. Results Mean adrenocorticotropic hormone 1–24 concentration did not differ significantly when flushed via plastic tube or measured in the aliquot solution ( P = 0.25). In vivo, mean 30-min serum cortisol concentrations were 20.47 ± 2.87 and 21.62 ± 3.89 μg/dl in via plastic tube and in via direct intravenous injection tests, respectively, and did not show a significant difference ( P = 0.16). Conclusions In low-dose test, using a 2.5 cm plastic tube ensures completeness of the intravenous adrenocorticotropic hormone injection dosage and provides equivalent cortisol responses.
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performance of low dose Cosyntropin stimulation test handled via plastic tube
Endocrine, 2017Co-Authors: Leonard Saiegh, Asala Abuahmad, Mohammad Sheikhahmad, Maria Reut, Limor Chenkonak, Nizar Jiries, Carmela ShechnerAbstract:Purpose Studies on 1 μg low-dose test showed that among 1 μg Cosyntropin samples pushed through long IV plastic tubing, some adrenocorticotropic hormone dosage was not recovered, and in healthy volunteers it provided subnormal cortisol responses. The aim of the current study is to assess whether there is any loss in adrenocorticotropic hormone 1–24 concentration when pushed through a short plastic tube, and to assess serum and salivary cortisol responses in low-dose test among healthy volunteers, using a similar short plastic tube vs. direct intravenous consyntropin injection.
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, Natalie Norton, G L Heusner, 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, Natalie Norton, G L Heusner, 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.
Gian Paolo Rossi - One of the best experts on this subject based on the ideXlab platform.
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adrenal venous sampling Cosyntropin stimulation or not
European Journal of Endocrinology, 2019Co-Authors: Jaap Deinum, Livia Lenzini, Hans Groenewoud, Gert Jan Van Der Wilt, Gian Paolo RossiAbstract:Notwithstanding the high prevalence of primary aldosteronism (PA), probably the most common form of secondary hypertension, the diagnosis of PA is often neglected or delayed, thus precluding target treatment, which is curative in many cases. For selection of the most appropriate treatment, a fundamental step is the distinction between a lateralized form, mainly aldosterone-producing adenoma (APA), and bilateral adrenocortical hyperplasia (BAH), also known as idiopathic hyperaldosteronism (IHA). To this aim all current guidelines recommend adrenal vein sampling (AVS), a technically challenging procedure that often fails, particularly in non-experienced hands. Cosyntropin (synthetic ACTH) is administered in the attempt to maximize adrenal cortisol secretion and avoid pulsatile adrenocortical hormone secretion in about 40% of the referral centres around the world. However, the Endocrine Society guidelines do not advise about the use or not of Cosyntropin as stimulus during AVS, as there are arguments in favour and against its use. These arguments are presented in this debate article reflecting the views of groups that currently use and do not use Cosyntropin.
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subtyping of primary aldosteronism with adrenal vein sampling hormone and side specific effects of Cosyntropin and metoclopramide
Surgery, 2017Co-Authors: Giacomo Rossitto, Giuseppe Maiolino, Livia Lenzini, Valeria Bisogni, Teresa Maria Seccia, Maurizio Cesari, Maurizio Iacobone, Gian Paolo RossiAbstract:Abstract Background Cosyntropin and metoclopramide can affect the subtyping of primary aldosteronism when used with adrenal vein sampling by exerting hormone- and side-specific effects on cortisol and aldosterone secretion. We investigated how these stimuli affect the selectivity index, the relative aldosterone secretion index, and the lateralization index in consecutive primary aldosteronism patients submitted to adrenal vein sampling. Methods We recruited 171 patients; of these, 149 underwent adrenal vein sampling before and after stimulation with Cosyntropin (250 µg intravenous bolus, n = 53, 73% with an aldosterone-producing adenoma) or with metoclopramide (10 mg intravenous bolus, n = 96, 65% aldosterone-producing adenoma), and 32 with an aldosterone-producing adenoma were investigated for the relative gene expression of dopamine, melanocortin 2, and 5-hydroxytryptamine (serotonin) 4 receptor with microarrays. Cosyntropin increased the selectivity index similarly on both sides; metoclopramide did not. Cosyntropin decreased relative aldosterone secretion index on the aldosterone-producing adenoma side but not contralaterally. Metoclopramide did not affect the selectivity index, but increased the relative aldosterone secretion index similarly on both sides. Because of these changes, Cosyntropin decreased the lateralization index, while metoclopramide did not affect it. The relative gene expression of melanocortin 2, albeit heterogeneous across tumors, was 35% less (P Conclusion Cosyntropin, while facilitating ascertainment of selectivity, lessens the lateralization, likely because of a blunted melanocortin 2 expression in aldosterone-producing adenoma. The similar expression of dopamine and 5-hydroxytryptamine (serotonin) 4 receptors in aldosterone-producing adenoma and the normal adrenal cortex can explain why metoclopramide increased the relative aldosterone secretion index on both sides and, therefore, failed to increase the lateralization index.
Jaap Deinum - One of the best experts on this subject based on the ideXlab platform.
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adrenal venous sampling Cosyntropin stimulation or not
European Journal of Endocrinology, 2019Co-Authors: Jaap Deinum, Livia Lenzini, Hans Groenewoud, Gert Jan Van Der Wilt, Gian Paolo RossiAbstract:Notwithstanding the high prevalence of primary aldosteronism (PA), probably the most common form of secondary hypertension, the diagnosis of PA is often neglected or delayed, thus precluding target treatment, which is curative in many cases. For selection of the most appropriate treatment, a fundamental step is the distinction between a lateralized form, mainly aldosterone-producing adenoma (APA), and bilateral adrenocortical hyperplasia (BAH), also known as idiopathic hyperaldosteronism (IHA). To this aim all current guidelines recommend adrenal vein sampling (AVS), a technically challenging procedure that often fails, particularly in non-experienced hands. Cosyntropin (synthetic ACTH) is administered in the attempt to maximize adrenal cortisol secretion and avoid pulsatile adrenocortical hormone secretion in about 40% of the referral centres around the world. However, the Endocrine Society guidelines do not advise about the use or not of Cosyntropin as stimulus during AVS, as there are arguments in favour and against its use. These arguments are presented in this debate article reflecting the views of groups that currently use and do not use Cosyntropin.
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plasma metanephrine for assessing the selectivity of adrenal venous sampling
Hypertension, 2013Co-Authors: Tanja Dekkers, Mirko Peitzsch, Jaap Deinum, Leo J Schultzekool, D Blondin, Oliver Vonend, Ad Rmm R Hermus, Lars Christian Rump, G Antoch, Fred C.g.j. SweepAbstract:Adrenal vein sampling is used to establish the origins of excess production of adrenal hormones in primary aldosteronism. Correct catheter positioning is confirmed using adrenal vein measurements of cortisol, but this parameter is not always reliable. Plasma metanephrine represents an alternative parameter. The objective of our study was to determine the use of plasma metanephrine concentrations to establish correct catheter positioning during adrenal vein sampling with and without Cosyntropin stimulation. We included 52 Cosyntropin-stimulated and 34 nonstimulated sequential procedures. Plasma cortisol and metanephrine concentrations were measured in adrenal and peripheral venous samples. Success rates of sampling, using an adrenal to peripheral cortisol selectivity index of 3.0, were compared with success rates of metanephrine using a selectivity index determined by receiver operating characteristic curve analysis. Among procedures assessed as selective using cortisol, the adrenal to peripheral vein ratio of metanephrine was 6-fold higher than that of cortisol (94.0 versus 15.5; P<0.0001). There were significant positive relationships between adrenal to peripheral vein ratios of cortisol and metanephrine for Cosyntropin-stimulated samplings but not for nonstimulated samplings. Receiver operating characteristic curve analysis indicated a plasma metanephrine selectivity index cutoff of 12. Using this cutoff, concordance in sampling success rates determined by cortisol and metanephrine was substantially higher in Cosyntropin-stimulated than in nonstimulated samplings (98% versus 59%). For the latter procedures, sampling success rates determined by metanephrine were higher (P<0.01) than those determined by cortisol (91% versus 56%). In conclusion, metanephrine provides a superior analyte compared with cortisol in assessing the selectivity of adrenal vein sampling during procedures without Cosyntropin stimulation.
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Plasma Metanephrine for Assessing the Selectivity of Adrenal Venous Sampling
Hypertension (Dallas Tex. : 1979), 2013Co-Authors: Tanja Dekkers, Mirko Peitzsch, Jaap Deinum, D Blondin, Oliver Vonend, Ad Rmm R Hermus, Lars Christian Rump, G Antoch, Leo J. Schultze-kool, Fred C.g.j. SweepAbstract:Adrenal vein sampling is used to establish the origins of excess production of adrenal hormones in primary aldosteronism. Correct catheter positioning is confirmed using adrenal vein measurements of cortisol, but this parameter is not always reliable. Plasma metanephrine represents an alternative parameter. The objective of our study was to determine the use of plasma metanephrine concentrations to establish correct catheter positioning during adrenal vein sampling with and without Cosyntropin stimulation. We included 52 Cosyntropin-stimulated and 34 nonstimulated sequential procedures. Plasma cortisol and metanephrine concentrations were measured in adrenal and peripheral venous samples. Success rates of sampling, using an adrenal to peripheral cortisol selectivity index of 3.0, were compared with success rates of metanephrine using a selectivity index determined by receiver operating characteristic curve analysis. Among procedures assessed as selective using cortisol, the adrenal to peripheral vein ratio of metanephrine was 6-fold higher than that of cortisol (94.0 versus 15.5; P
