Skip to main content
Top
Published in: Endocrine 1/2017

01-07-2017 | Endocrine Methods and Techniques

Performance of low-dose cosyntropin stimulation test handled via plastic tube

Authors: Leonard Saiegh, Asala Abu-Ahmad, Mohammad Sheikh-Ahmad, Maria Reut, Limor Chen-Konak, Nizar Jiries, Carmela Shechner

Published in: Endocrine | Issue 1/2017

Login to get access

Abstract

Purpose

Studies on 1 μg low-dose test showed that among 1 μg cosyntropin samples pushed through long IV plastic tubing, some adrenocorticotropic hormone dosage was not recovered, and in healthy volunteers it provided subnormal cortisol responses. The aim of the current study is to assess whether there is any loss in adrenocorticotropic hormone 1–24 concentration when pushed through a short plastic tube, and to assess serum and salivary cortisol responses in low-dose test among healthy volunteers, using a similar short plastic tube vs. direct intravenous consyntropin injection.

Methods

We evaluated in vitro if adrenocorticotropic hormone was absorbed in a 2.5 cm plastic tube by measuring adrenocorticotropic hormone 1–24 concentration in a 1 μg/ml adrenocorticotropic hormone aliquot solution before and after being flushed through the plastic tube. For the in vivo study, we recruited 20 healthy adult volunteers. Each subject underwent low-dose test via 2.5 cm plastic tube via plastic tube and via direct intravenous injection by a metal syringe via direct intravenous injection, and cortisol responses were determined.

Results

Mean adrenocorticotropic hormone 1–24 concentration did not differ significantly when flushed via plastic tube or measured in the aliquot solution (P = 0.25). In vivo, mean 30-min serum cortisol concentrations were 20.47 ± 2.87 and 21.62 ± 3.89 μg/dl in via plastic tube and in via direct intravenous injection tests, respectively, and did not show a significant difference (P = 0.16).

Conclusions

In low-dose test, using a 2.5 cm plastic tube ensures completeness of the intravenous adrenocorticotropic hormone injection dosage and provides equivalent cortisol responses.
Literature
1.
go back to reference J.B. Wood, A.W. Frankland, V.H. James, J. Landon, A rapid test of adrenocortical function. Lancet. 30, 243–245 (1965)CrossRef J.B. Wood, A.W. Frankland, V.H. James, J. Landon, A rapid test of adrenocortical function. Lancet. 30, 243–245 (1965)CrossRef
2.
go back to reference B. Ambrosi, L. Barbetta, T. Re, E. Passini, G. Faglia, The one microgram adrenocorticotropin test in the assessment of hypothalamic-pituitary-adrenal function. Eur. J. Endocrinol. 139, 575–579 (1998)CrossRef B. Ambrosi, L. Barbetta, T. Re, E. Passini, G. Faglia, The one microgram adrenocorticotropin test in the assessment of hypothalamic-pituitary-adrenal function. Eur. J. Endocrinol. 139, 575–579 (1998)CrossRef
3.
go back to reference G. Dickstein, C. Shechner, W.E. Nicholson, I. Rosner, Z. Shen-Orr, F. Adawi, M. Lahav, Adrenocorticotropin stimulation test: effects of basal cortisol level, time of day, and suggested new sensitive low dose test. J. Clin. Endocrinol. Metab. 72, 773–778 (1991)CrossRef G. Dickstein, C. Shechner, W.E. Nicholson, I. Rosner, Z. Shen-Orr, F. Adawi, M. Lahav, Adrenocorticotropin stimulation test: effects of basal cortisol level, time of day, and suggested new sensitive low dose test. J. Clin. Endocrinol. Metab. 72, 773–778 (1991)CrossRef
4.
go back to reference K. Tordjman, A. Jaffe, N. Grazas, C. Apter, N.J. Stern, The role of the low dose (1 microgram) adrenocorticotropin test in the evaluation of patients with pituitary diseases. J. Clin. Endocrinol. Metab. 80, 1301–1305 (1995)PubMed K. Tordjman, A. Jaffe, N. Grazas, C. Apter, N.J. Stern, The role of the low dose (1 microgram) adrenocorticotropin test in the evaluation of patients with pituitary diseases. J. Clin. Endocrinol. Metab. 80, 1301–1305 (1995)PubMed
5.
go back to reference S. Rasmuson, T. Olsson, E. Hagg, A low dose ACTH test to assess the function of the hypothalamic-pituitary-adrenal axis. Clin. Endocrinol. 44, 151–156 (1996)CrossRef S. Rasmuson, T. Olsson, E. Hagg, A low dose ACTH test to assess the function of the hypothalamic-pituitary-adrenal axis. Clin. Endocrinol. 44, 151–156 (1996)CrossRef
6.
go back to reference T.A. Abdu, T.A. Elhadd, R. Neary, R.N. Clayton, Comparison of the low dose short synacthen test (1 microg), the conventional dose short synacthen test (250 microg), and the insulin tolerance test for assessment of the hypothalamo-pituitary-adrenal axis in patients with pituitary disease. J. Clin. Endocrinol. Metab. 84, 838–843 (1999)PubMed T.A. Abdu, T.A. Elhadd, R. Neary, R.N. Clayton, Comparison of the low dose short synacthen test (1 microg), the conventional dose short synacthen test (250 microg), and the insulin tolerance test for assessment of the hypothalamo-pituitary-adrenal axis in patients with pituitary disease. J. Clin. Endocrinol. Metab. 84, 838–843 (1999)PubMed
7.
go back to reference R. Kazlauskaite, A.T. Evans, C.V. Villabona, T.A. Abdu, B. Ambrosi, A.B. Atkinson, C.H. Choi, R.N. Clayton, C.H. Courtney, E.N. Gonc, M. Maghnie, S.R. Rose, S.G. Soule, K. Tordjman, Corticotropin tests for hypothalamic-pituitary- adrenal insufficiency: a metaanalysis. J. Clin. Endocrinol. Metab. 93, 4245–4253 (2008)CrossRef R. Kazlauskaite, A.T. Evans, C.V. Villabona, T.A. Abdu, B. Ambrosi, A.B. Atkinson, C.H. Choi, R.N. Clayton, C.H. Courtney, E.N. Gonc, M. Maghnie, S.R. Rose, S.G. Soule, K. Tordjman, Corticotropin tests for hypothalamic-pituitary- adrenal insufficiency: a metaanalysis. J. Clin. Endocrinol. Metab. 93, 4245–4253 (2008)CrossRef
8.
go back to reference A. Beishuizen, J.H. van Lijf, J.F. Lekkerkerker, I. Vermes, The low dose (1 microg) ACTH stimulation test for assessment of the hypothalamo-pituitary-adrenal axis. Neth. J. Med. 56, 91–99 (2000)CrossRef A. Beishuizen, J.H. van Lijf, J.F. Lekkerkerker, I. Vermes, The low dose (1 microg) ACTH stimulation test for assessment of the hypothalamo-pituitary-adrenal axis. Neth. J. Med. 56, 91–99 (2000)CrossRef
9.
go back to reference G. Dickstein, L. Saiegh, Low-dose and high-dose adrenocorticotropin testing: indications and shortcomings. Curr. Opin. Endocrinol. Diabetes. Obes. 15, 244–249 (2008)CrossRef G. Dickstein, L. Saiegh, Low-dose and high-dose adrenocorticotropin testing: indications and shortcomings. Curr. Opin. Endocrinol. Diabetes. Obes. 15, 244–249 (2008)CrossRef
10.
go back to reference G. Reimondo, S. Bovio, B. Allasino, M. Terzolo, A. Angeli, Secondary hypoadrenalism. Pituitary. 11, 147–154 (2008)CrossRef G. Reimondo, S. Bovio, B. Allasino, M. Terzolo, A. Angeli, Secondary hypoadrenalism. Pituitary. 11, 147–154 (2008)CrossRef
11.
go back to reference Y.J. Park, K.S. Park, J.H. Kim, C.S. Shin, S.Y. Kim, H.K. Lee, Reproducibility of the cortisol response to stimulation with the low dose (1 microg) of ACTH. Clin. Endocrinol. 51, 153–158 (1999)CrossRef Y.J. Park, K.S. Park, J.H. Kim, C.S. Shin, S.Y. Kim, H.K. Lee, Reproducibility of the cortisol response to stimulation with the low dose (1 microg) of ACTH. Clin. Endocrinol. 51, 153–158 (1999)CrossRef
12.
go back to reference J.G. Gonzalez-Gonzalez, N.E. De la Garza-Hernandez, L.G. Mancillas-Adame, J. Montes-Villarreal, J.Z. Villarreal-Perez, A high-sensitivity test in the assessment of adrenocortical insufficiency: 10 microg vs 250 microg cosyntropin dose assessment of adrenocortical insufficiency. J. Endocrinol. 159, 275–280 (1998)CrossRef J.G. Gonzalez-Gonzalez, N.E. De la Garza-Hernandez, L.G. Mancillas-Adame, J. Montes-Villarreal, J.Z. Villarreal-Perez, A high-sensitivity test in the assessment of adrenocortical insufficiency: 10 microg vs 250 microg cosyntropin dose assessment of adrenocortical insufficiency. J. Endocrinol. 159, 275–280 (1998)CrossRef
13.
go back to reference H. Murphy, J. Livesey, E.A. Espiner, R.A. Donald, The low dose ACTH test--a further word of caution. J. Clin. Endocrinol. Metab. 83, 712–713 (1998)CrossRef H. Murphy, J. Livesey, E.A. Espiner, R.A. Donald, The low dose ACTH test--a further word of caution. J. Clin. Endocrinol. Metab. 83, 712–713 (1998)CrossRef
14.
go back to reference M. Wade, S. Baid, K. Calis, H. Raff, N. Sinaii, L. Nieman, Technical details influence the diagnostic accuracy of the 1 microg ACTH stimulation test. Eur. J. Endocrinol. 162, 109–113 (2010)CrossRef M. Wade, S. Baid, K. Calis, H. Raff, N. Sinaii, L. Nieman, Technical details influence the diagnostic accuracy of the 1 microg ACTH stimulation test. Eur. J. Endocrinol. 162, 109–113 (2010)CrossRef
15.
go back to reference L.K. Nieman, Dynamic evaluation of adrenal hypofunction. J. Endocrinol. Invest. 26, 74–82 (2003)PubMed L.K. Nieman, Dynamic evaluation of adrenal hypofunction. J. Endocrinol. Invest. 26, 74–82 (2003)PubMed
16.
go back to reference M.G. Burt, B.L. Mangelsdorf, A. Rogers, J.T. Ho, J.G. Lewis, W.J. Inder, M.P. Doogue, Free and total plasma cortisol measured by immunoassay and mass spectrometry following ACTH1–24 stimulation in the assessment of pituitary patients. J. Clin. Endocrinol. Metab. 98, 1883–1890 (2013)CrossRef M.G. Burt, B.L. Mangelsdorf, A. Rogers, J.T. Ho, J.G. Lewis, W.J. Inder, M.P. Doogue, Free and total plasma cortisol measured by immunoassay and mass spectrometry following ACTH1–24 stimulation in the assessment of pituitary patients. J. Clin. Endocrinol. Metab. 98, 1883–1890 (2013)CrossRef
17.
go back to reference L.C. Smans, P.M. Zelissen, Is diagnosis and subclassification of adrenal insufficiency as easy as it looks? Front. Horm. Res. 46, 146–158 (2016)CrossRef L.C. Smans, P.M. Zelissen, Is diagnosis and subclassification of adrenal insufficiency as easy as it looks? Front. Horm. Res. 46, 146–158 (2016)CrossRef
18.
go back to reference Y. Marcus-Perlman, K. Tordjman, Y. Greenman, R. Limor, G. Shenkerman, E. Osher, N. Stern, Low-dose ACTH (1 microg) salivary test: a potential alternative to the classical blood test. Clin. Endocrinol. 64, 215–258 (2006)CrossRef Y. Marcus-Perlman, K. Tordjman, Y. Greenman, R. Limor, G. Shenkerman, E. Osher, N. Stern, Low-dose ACTH (1 microg) salivary test: a potential alternative to the classical blood test. Clin. Endocrinol. 64, 215–258 (2006)CrossRef
19.
go back to reference I. Perogamvros, L.J. Owen, B.G. Keevil, G. Brabant, P.J. Trainer, Measurement of salivary cortisol with liquid chromatography-tandem mass spectrometry in patients undergoing dynamic endocrine testing. Clin. Endocrinol. 72, 17–21 (2010)CrossRef I. Perogamvros, L.J. Owen, B.G. Keevil, G. Brabant, P.J. Trainer, Measurement of salivary cortisol with liquid chromatography-tandem mass spectrometry in patients undergoing dynamic endocrine testing. Clin. Endocrinol. 72, 17–21 (2010)CrossRef
20.
go back to reference W.J. Inder, G. Dimeski, A. Russell, Measurement of salivary cortisol in 2012 - laboratory techniques and clinical indications. Clin. Endocrinol. 77, 645–651 (2012)CrossRef W.J. Inder, G. Dimeski, A. Russell, Measurement of salivary cortisol in 2012 - laboratory techniques and clinical indications. Clin. Endocrinol. 77, 645–651 (2012)CrossRef
21.
go back to reference M.P. Cornes, H.L. Ashby, Y. Khalid, H.N. Buch, C. Ford, R. Gama, Salivary cortisol and cortisone responses to tetracosactrin (synacthen). Ann. Clin. Biochem. 52, 606–610 (2015)CrossRef M.P. Cornes, H.L. Ashby, Y. Khalid, H.N. Buch, C. Ford, R. Gama, Salivary cortisol and cortisone responses to tetracosactrin (synacthen). Ann. Clin. Biochem. 52, 606–610 (2015)CrossRef
22.
go back to reference J. Cartaya, M. Misra, The low-dose ACTH stimulation test: is 30 minutes long enough? Endocr. Pract. 21, 508–513 (2015)CrossRef J. Cartaya, M. Misra, The low-dose ACTH stimulation test: is 30 minutes long enough? Endocr. Pract. 21, 508–513 (2015)CrossRef
23.
go back to reference A. Salcido-Montenegro, K.E. Carlos-Reyna, H.E. Tamez-Pérez, J.G. González-González, Low-dose ACTH stimulation test: dose, sampling time, and technical issues. Endocr. Pract. 21, 1079 (2015)CrossRef A. Salcido-Montenegro, K.E. Carlos-Reyna, H.E. Tamez-Pérez, J.G. González-González, Low-dose ACTH stimulation test: dose, sampling time, and technical issues. Endocr. Pract. 21, 1079 (2015)CrossRef
Metadata
Title
Performance of low-dose cosyntropin stimulation test handled via plastic tube
Authors
Leonard Saiegh
Asala Abu-Ahmad
Mohammad Sheikh-Ahmad
Maria Reut
Limor Chen-Konak
Nizar Jiries
Carmela Shechner
Publication date
01-07-2017
Publisher
Springer US
Published in
Endocrine / Issue 1/2017
Print ISSN: 1355-008X
Electronic ISSN: 1559-0100
DOI
https://doi.org/10.1007/s12020-017-1330-5

Other articles of this Issue 1/2017

Endocrine 1/2017 Go to the issue
Obesity Clinical Trial Summary

At a glance: The STEP trials

A round-up of the STEP phase 3 clinical trials evaluating semaglutide for weight loss in people with overweight or obesity.

Developed by: Springer Medicine

Highlights from the ACC 2024 Congress

Year in Review: Pediatric cardiology

Watch Dr. Anne Marie Valente present the last year's highlights in pediatric and congenital heart disease in the official ACC.24 Year in Review session.

Year in Review: Pulmonary vascular disease

The last year's highlights in pulmonary vascular disease are presented by Dr. Jane Leopold in this official video from ACC.24.

Year in Review: Valvular heart disease

Watch Prof. William Zoghbi present the last year's highlights in valvular heart disease from the official ACC.24 Year in Review session.

Year in Review: Heart failure and cardiomyopathies

Watch this official video from ACC.24. Dr. Biykem Bozkurt discuss last year's major advances in heart failure and cardiomyopathies.