title: The low-dose ACTH test does not identify mild insufficiency of the hypothalamnic-pituitary-adrenal axis in children with inadequate stress response.
abstract: OBJECTIVE
  To investigate retrospectively the sensitivity of published cortisol cut-off points of the low-dose ACTH test (LDAT) in children with proven mild hypothalamic-pituitary-adrenal (HPA) axis insufficiency.
  
  
  METHODS
  The HPA axis of 11 pediatric patients (age range: 5.5-14.5 yr) with established mild HPA axis insufficiency was reinvestigated with the LDAT. The sensitivity of the LDAT was calculated on the basis of published stimulated cortisol cut-off points.
  
  
  RESULTS
  The LDAT showed both a significantly higher cortisol peak and a greater cortisol rise compared with the ITT (both P < 0.01). The LDAT yielded a low sensitivity of 9-55% using published cortisol cut-off points as references.
  
  
  CONCLUSIONS
  Using published cortisol cut-off points, the LDAT showed a poor sensitivity to detect mild HPA axis insufficiency. We cannot recommend the use of the LDAT as a screening test of HPA axis impairment in such children.
authors.affiliation: Department of Pediatrics, Division of Pediatric Endocrinology, Johann Wolfgang Goethe-University, Frankfurt, Germany. clemens.kamrath@kgu.de
authors.forename: Clemens
authors.initials: C
authors.lastname: Kamrath
authors.forename: Hansjosef
authors.initials: H
authors.lastname: Boehles
mesh_terms: D000293:Adolescent; D000309:Adrenal Insufficiency / Q000175:diagnosis*; D000324:Adrenocorticotropic Hormone; D002648:Child; D002675:Child, Preschool; D005260:Female; D006801:Humans; D006854:Hydrocortisone / Q000097:blood; D007030:Hypothalamo-Hypophyseal System / Q000503:physiopathology*; D007333:Insulin Resistance; D008297:Male; D010900:Pituitary Diseases / Q000175:diagnosis*; D010913:Pituitary-Adrenal System / Q000503:physiopathology*; D012189:Retrospective Studies; D012680:Sensitivity and Specificity; D013315:Stress, Psychological / Q000503:physiopathology*
chemical_list: D000324:Adrenocorticotropic Hormone; D006854:Hydrocortisone