title: Utility of 30 and 60 minute cortisol samples after high-dose synthetic ACTH-1-24 injection in the diagnosis of adrenal insufficiency.
abstract: BACKGROUND
  In clinical practise the high dose ACTH stimulation test (HDT) is frequently used in the assessment of adrenal insufficiency (AI). However, there is uncertainty regarding optimal time-points and number of blood samplings. The present study compared the utility of a single cortisol value taken either 30 or 60 minutes after ACTH stimulation with the traditional interpretation of the HDT.
  
  
  METHODS
  Retrospective analysis of 73 HDT performed at a single tertiary endocrine centre. Serum cortisol was measured at baseline, 30 and 60 minutes after intravenous administration of 250 µg synthetic ACTH1-24. Adrenal insufficiency (AI) was defined as a stimulated cortisol level <550 nmol/l.
  
  
  RESULTS
  There were twenty patients (27.4%) who showed an insufficient rise in serum cortisol using traditional HDT criteria and were diagnosed to suffer from AI. There were ten individuals who showed insufficient cortisol values after 30 minutes, rising to sufficient levels at 60 minutes. All patients revealing an insufficient cortisol response result after 60 minutes also had an insufficient result after 30 minutes. The cortisol value taken after 30 minutes did not add incremental diagnostic value in any of the cases under investigation compared with the 60 minutes' sample.
  
  
  CONCLUSIONS
  Based on the findings of the present analysis the utility of a cortisol measurement 30 minutes after high dose ACTH injection was low and did not add incremental diagnostic value to a single measurement after 60 minutes.
authors: Division of Endocrinology, Diabetes & Clinical Nutrition, Inselspital, Bern University Hospital, and University of Bern, Switzerland.
authors: Thomas
authors: T
authors: Zueger
authors: Division of Endocrinology, Diabetes & Clinical Nutrition, Inselspital, Bern University Hospital, and University of Bern, Switzerland.
authors: Marlen
authors: M
authors: Jordi
authors: Department of Internal Medicine I, Innsbruck Medical University, Innsbruck, Austria.
authors: Markus
authors: M
authors: Laimer
authors: Division of Endocrinology, Diabetes & Clinical Nutrition, Inselspital, Bern University Hospital, and University of Bern, Switzerland.
authors: Christoph
authors: C
authors: Stettler
mesh_terms: D000309:Adrenal Insufficiency / Q000097:blood / Q000175:diagnosis*; D000328:Adult; D000368:Aged; D015415:Biomarkers / Q000097:blood; D003366:Cosyntropin; D005260:Female; D006728:Hormones; D006801:Humans; D006854:Hydrocortisone / Q000097:blood*; D008297:Male; D008875:Middle Aged; D012189:Retrospective Studies; D013997:Time Factors
chemical_list: D015415:Biomarkers; D006728:Hormones; D003366:Cosyntropin; D006854:Hydrocortisone