- The Effect of Low Dose and High Dose ACTH in the Evaluation of Adrenal Function.
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Hyung Joon Yoo, Sung Hee Ihm, Sung Woo Park, Jae Hwan Jee, Hyun Kyu Kim, Doo Man Kim, Jae Myoung Yoo, Moon Ki Choi
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J Korean Endocr Soc. 1998;13(4):580-589. Published online January 1, 2001
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 Abstract
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- BACKGROUND
Pharmacological ACTH test provide information only about the ability of the adrenal gland to respond to unusual stimuli and may not reflect the daily cortisol secretion. There were some controversies in the diagnosis of mild adrenal insufficiency by using a pharmacological dose of ACTH. The purpose of the present study was to assess and compare the effect of low dose 1 pg ACTH and high dose 249 pg ACTH in the evaluation of adrenal function. The intravenous injection of a pharmacological dose(250 pg) of ACTH has been used as a standard test in the initial assessment of adrenal function. So we low dose ACTH to evaluate the adrenal function and compare the result of high dose ACTH. METHOD: Basal serum cortisol sampling was done at 2:00 p.m.. And after 1 pg ACTH iv bolus injection, cortisol sampling was done at 20, 30, 45 and 60 min respectively. On the next day same procedure was repeated at same time, but 249 mg ACTH was given instead of the low dose. Normal adrenal function was diagnosed with the criteria of stimulated serum cortisol concentration over 20 mg/dL. Total 65 patients took part in this study. Three hypopituitarism patients and one Addisons disease were included. Sixty-one patients had the history of glucocorticoid ingestion or had physical findings of cushingoid features with symptoms suggest the adrenal insufficiency. RESULTS: Sixteen patients showed normal response to both low dose and high dose ACTH. Thirty-six patients were not stimulated to both low dose and high dose ACTH. The remaining thirteen patients revealed normal response to high dose ACTH, but not to low dose ACTH. CONCLUSION: It appears that low dose ACTH stimulation test is more sensitive and specific than high dose ACTH and is capable of revealing mild adrenal insufficiency.
- A Case of Cushing's Syndrome in Pregnancy due to Adrenal Adenoma.
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Hyung Joon Yoo, Sung Hee Ihm, Sung Woo Park, Hae Sung Yim, Yong Tae Kim, Chul Hee Park, Hyun Kyu Kim, Doo Man Kim, Jae Myoung Yoo, Moon Ki Choi
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J Korean Endocr Soc. 1998;13(2):264-270. Published online January 1, 2001
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Abstract
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- Cushings syndrome in pregnancy is rare. This is explained by the syndromes association with amencerhea, infertility and abortions. Matemal and fetal risks increase markedly when pregnancy does occur in woman with hypercortisolism. Since pregnant women without Cushings syndrome develop some features of Cushings syndrome, such as hypertension, hyperglycemia and striae, a high index of clinical suspician must be maintained to prevent delay in diagnosis. The physiologic changes in adrenocorticostemid metabolism during pregnancy further complieate the diagnosis. We describe a case of Cushings syndmme in pregnancy secondary to an adrenal cortical adenoma which was diagnosed immediately after a preterm delivery in 24-year-old woman with preeclampsia.
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