การเปรียบเทียบผลการทดสอบการทำงานของต่อมหมวกไต โดยการกระตุ้นด้วยฮอร์โมนอะดรีโนคอร์ติโคโทรปิน และการทดสอบความทนต่ออินสุลินในภาวะต่อมหมวกไตบกพร่องทุติยภูมิ / ณรงค์ วณิชย์นิรมล = Comparison of adrenal function test with adrenocorticotropic hormone stimulation test and insulin tolerance test in secondary adrenal insufficiency / Narong Vanichaniramol
Background: The insulin tolerance test (ITT) is widely accepted as the gold standard dynamic stimulation test of adrenal function, but it may be hazardous. The standard synthetic ACTH test has been advocated as a substitute but the accuracy remains controversy because of supraphysiologic stimulation. Objective: To compare the diagnostic value of the ITT with a low dose ACTH stimulation test (1µg.) and the standard ACTH stimulation test (250 µg.) Subject and method: Six men and ten women post operative for pituitary surgery were studied. ITT, low dose (1 µg.) and standard (250 µg.) ACTH tests were performed in all patients. Blood samples for serum cortisol were collected at 0,30,60 minutes for standard ACTH test and 0,20,30,60 minuted for 1 µg.test. Data were completely collected in fourteen patients. Measurement: Serum cortisol was determined by RIA method. The peak cortisol values during insulin tolerance were compared to the cortisol levels from both ACTH tests. Result : The 1 µg. (low dose) ACTH stimulation test had higher sensitivity (80%) than standard ACTH stimulation test (sensitivity = 70%). Both tests had equivalent specificity for assessment of secondary adrenal insufficiency. Conclusion : The 1 µg. ACTH test was more sensitive test than standard ACTH and it canbe an alternative test for the evaluation of adrenal function in subjects that cannot tolerance hypoglycemia during the insulin tolerance test.
