title: Effects of endogenous and exogenous hypercortisolemia on low-dose adrenocorticotropin test outcome in humans.
abstract: BACKGROUND
  The results of low-dose ACTH testing may be impaired during endogenous or exogenous hypercortisolemia in various clinical situations.
  
  
  OBJECTIVE
  The hypothesized inhibitory effects of hypercortisolemia on adrenal responsiveness to low-dose ACTH were tested in two model situations in healthy humans.
  
  
  METHODS
  Nine young healthy women underwent low-dose ACTH test in 5 modifications. In ACTH-ACTH test, ACTH (1 microg iv) was given at 09:00 h and 10:00 h. Two control tests consisted of single ACTH bolus at 09:00 h or at 10:00 h. In hydrocortisone (HC)-ACTH test, HC (20 mg po) was given at 08:30 h and ACTH was injected at 10:00 h. Control test consisted of single HC administration at 08:30 h.
  
  
  RESULTS
  Cortisol response after the 2nd ACTH test was significantly lower vs the 1st ACTH bolus (Deltamax: 166+/-32 nmol/l vs 276+/-15 nmol/l, p<0.05) in ACTH-ACTH test. Responses of other steroids after both ACTH injections were comparable. ACTH bolus during HC-induced hypercortisolemia caused a slight increase in cortisol level and prevented its decrease, seen after HC administration alone. Adrenal cortisol production in response to ACTH bolus under different incipient conditions (baseline, physiological, and pharmacological hypercortisolemia; 180+/-16, 173+/-21, and 177+/-53 nmol.min.l-1, respectively) did not significantly differ (p=0.8).
  
  
  CONCLUSIONS
  Endogenous and exogenous hypercortisolemia did not influence adrenal cortisol response to low-dose ACTH test indicating lack of its negative feedback at adrenal level.
authors.affiliation: Laboratory of Human Endocrinology, Institute of Experimental Endocrinology, Slovak Academy of Sciences, Vlarska 3, 833 06, Bratislava, Slovakia. jana.kerlik@savba.sk
authors.forename: J
authors.initials: J
authors.lastname: Kerlik
authors.forename: A
authors.initials: A
authors.lastname: Penesova
authors.forename: M
authors.initials: M
authors.lastname: Vlcek
authors.forename: R
authors.initials: R
authors.lastname: Imrich
authors.forename: L
authors.initials: L
authors.lastname: Starka
authors.forename: Z
authors.initials: Z
authors.lastname: Radikova
mesh_terms: D019326:17-alpha-Hydroxyprogesterone / Q000097:blood; D000324:Adrenocorticotropic Hormone; D000328:Adult; D000735:Androstenedione / Q000097:blood; D003480:Cushing Syndrome / Q000097:blood; D003687:Dehydroepiandrosterone / Q000097:blood; D005260:Female; D006801:Humans; D006854:Hydrocortisone / Q000008:administration & dosage / Q000097:blood*; D007030:Hypothalamo-Hypophyseal System / Q000502:physiology; D010912:Pituitary-Adrenal Function Tests / Q000379:methods*; D010913:Pituitary-Adrenal System / Q000502:physiology
chemical_list: D000735:Androstenedione; D003687:Dehydroepiandrosterone; D019326:17-alpha-Hydroxyprogesterone; D000324:Adrenocorticotropic Hormone; D006854:Hydrocortisone