Impaired adrenal reserve in men with spinal cord injury: results of low- and high-dose adrenocorticotropin stimulation tests.
OBJECTIVE
To use low- and high-dose adrenocorticotropin (ACTH) tests to assess adrenal reserve in men with spinal cord injury (SCI).


METHODS
After an overnight fast, 1 microg and 200 microg ACTH were injected intravenously at time 0 and 60 minutes between 8 AM and 9 AM. Blood was withdrawn at 30-minute intervals from time 0 to 120 minutes.


METHODS
All participants were recruited from the outpatient clinic of a university hospital that is a tertiary referral center.


METHODS
Forty-two men with traumatic neurologically complete SCI that had occurred more than 1 year before the study.


METHODS
Serum cortisol response to ACTH at times 0, 30, 60, 90, and 120 minutes.


RESULTS
Twenty subjects had a serum cortisol response of <20 microg/dL 30 minutes after a 1-microg ACTH injection; 10 of these remained at this level at 30 minutes after a 200-microg ACTH injection.


CONCLUSIONS
There is a high prevalence of impaired adrenal reserve in persons with chronic SCI. The 1-microg (low dose) ACTH test is more sensitive for detecting subclinical adrenal insufficiency than is the 200-microg (high dose) ACTH test.
Wang
Y H
YH
Department of Physical Medicine and Rehabilitation, College of Medicine, National Taiwan University, Taipei.
Huang
T S
TS
D000311:Adrenal Glands / Q000187:drug effects* / Q000503:physiopathology; D000309:Adrenal Insufficiency / Q000097:blood / Q000175:diagnosis / Q000209:etiology; D000324:Adrenocorticotropic Hormone / Q000008:administration & dosage / Q000097:blood; D000328:Adult; D002908:Chronic Disease; D004305:Dose-Response Relationship, Drug; D006801:Humans; D006854:Hydrocortisone / Q000097:blood; D008297:Male; D008875:Middle Aged; D012044:Regression Analysis; D012680:Sensitivity and Specificity; D013119:Spinal Cord Injuries / Q000097:blood / Q000150:complications / Q000503:physiopathology*; D013268:Stimulation, Chemical; D013997:Time Factors
D000324:Adrenocorticotropic Hormone; D006854:Hydrocortisone