title: Cortisol response in relation to the severity of stress and illness.
abstract: BACKGROUND
  The aim of the study was to compare the adrenal response, the course of the ACTH/cortisol ratio, as well as the variance and the diagnostic performance of different cutoffs after 1 and 250 microg ACTH stimulation in different stress situations.
  
  
  METHODS
  We investigated three groups with increasing stress levels: ambulatory controls (group A; n = 20), hospitalized medical patients (group B; n = 25), and patients undergoing coronary artery bypass grafting (group C; n = 29). All subjects underwent four consecutive ACTH stimulation tests and were randomized to either a 1- or 250-microg dose.
  
  
  RESULTS
  Stimulated cortisol levels in group A were similar to basal cortisol levels under maximal stress (C3; P = 0.8). Peak cortisol concentrations were higher after 250 microg compared with 1 microg ACTH in group B (P = 0.006) and under maximal stress after extubation (group C3; P = 0.027), whereas there were no differences in group A. The ACTH/cortisol ratio was lower in surgical patients after extubation compared with unstressed conditions (P < or = 0.03) The within-subject variance was similar in ambulatory controls and medical patients and after both ACTH doses (all 17-36% of total variance). Cutoff dependent, the diagnosis of relative adrenal insufficiency would have been made in 0-58.3%, respectively.
  
  
  CONCLUSIONS
  In moderate and major stress situations, cortisol concentrations in patients without hypothalamic-pituitary-adrenal disease were higher after stimulation with 250 microg compared with 1 mug ACTH. Data from our study give insight into the physiological adaptations of the hypothalamic-pituitary-adrenal axis to stress.
authors.affiliation: Division of Endocrinology, Diabetes, and Clinical Nutrition, University Hospital, Basel, Switzerland.
authors.forename: Isabelle E
authors.initials: IE
authors.lastname: Widmer
authors.forename: Jardena J
authors.initials: JJ
authors.lastname: Puder
authors.forename: Caroline
authors.initials: C
authors.lastname: König
authors.forename: Hans
authors.initials: H
authors.lastname: Pargger
authors.forename: Hans Reinhard
authors.initials: HR
authors.lastname: Zerkowski
authors.forename: Jürg
authors.initials: J
authors.lastname: Girard
authors.forename: Beat
authors.initials: B
authors.lastname: Müller
mesh_terms: D000222:Adaptation, Physiological; D000324:Adrenocorticotropic Hormone / Q000008:administration & dosage / Q000097:blood; D000328:Adult; D000368:Aged; D001026:Coronary Artery Bypass; D003324:Coronary Artery Disease / Q000097:blood* / Q000601:surgery; D003940:Diagnostic Techniques, Endocrine / Q000592:standards; D005260:Female; D006801:Humans; D006854:Hydrocortisone / Q000097:blood*; D007030:Hypothalamo-Hypophyseal System / Q000502:physiology; D008297:Male; D008875:Middle Aged; D010913:Pituitary-Adrenal System / Q000502:physiology; D015203:Reproducibility of Results; D012720:Severity of Illness Index; D013312:Stress, Physiological / Q000097:blood* / Q000175:diagnosis
chemical_list: D000324:Adrenocorticotropic Hormone; D006854:Hydrocortisone