Technical details influence the diagnostic accuracy of the 1 microg ACTH stimulation test.
OBJECTIVE
To examine the factors causing inadequate cortisol responses to the 1 microg ACTH stimulation test.


METHODS
Random test assignment (by age and gender) at 0800 or 1600 h.


METHODS
We recruited 20 healthy adults to each of the three age groups (<40 years, 40-55 years, and >55 years; half females in each group). ACTH stimulation tests were performed in an outpatient clinic at the NIH Clinical Research Center. Plasma cortisol was measured just before, and 30 and 60 min after the administration of 1 microg ACTH (1-24). The ACTH concentration in diluted and administered solutions was measured.


RESULTS
Twenty-five volunteers (19 at 1600 h) had a subnormal cortisol response (peak cortisol 10.4-17.5 microg/dl), using a criterion <18 microg/dl (497 nmol/l), for a specificity of 58% (confidence interval (CI) 45-71%). Afternoon testing had a significant impact on failure rates (odds ratio 6.98, CI 2.17-22.43), while gender and age did not. The stock solution contained 1 microg ACTH, but after administration through tubing it contained only 0.5-0.8 microg.


CONCLUSIONS
The high rate of abnormal results, especially in the afternoon, and loss of ACTH through tubing suggest that morning testing and minimal tubing should be adopted to avoid an inappropriate diagnosis of adrenal insufficiency. Earlier time points and standardized protocols would facilitate comparison of studies.
Program in Reproductive and Adult Endocrinology, National Institute of Child Health and Human Development Pharmacy Department, National Institutes of Health, Clinical Center, Bethesda, Maryland, USA.
Matthew
M
Wade
Smita
S
Baid
Karim
K
Calis
Hershel
H
Raff
Ninet
N
Sinaii
Lynnette
L
Nieman
D000309:Adrenal Insufficiency / Q000097:blood / Q000175:diagnosis; D000324:Adrenocorticotropic Hormone / Q000097:blood*; D000328:Adult; D000368:Aged; D003951:Diagnostic Errors; D003955:Diagnostic Tests, Routine / Q000379:methods* / Q000592:standards*; D005260:Female; D006801:Humans; D006854:Hydrocortisone / Q000097:blood; D008297:Male; D008875:Middle Aged; D012016:Reference Values; D012680:Sensitivity and Specificity; D055815:Young Adult
D000324:Adrenocorticotropic Hormone; D006854:Hydrocortisone