Skip to main content

Advertisement

SpringerLink
Log in

The comparison of low and standard dose ACTH and glucagon stimulation tests in the evaluation of hypothalamo-pituitary-adrenal axis in healthy adults

  • Published:
Pituitary Aims and scope Submit manuscript

Abstract

Evaluation of the HPA axis is still a challenge; due to different sensitivities and stimulation efficiencies of dynamic tests, lack of standard assays for cortisol measurement and lack of data regarding the effects of age and gender on the results of the HPA axis evaluation with different dynamic tests. This study was performed to compare 1 μg ACTH, 250 μg ACTH and glucagon tests in the evaluation of HPA axis. The study was carried out on 55 healthy individuals (28 men, 27 women). 10–12 volunteers were included from every decades between 20 and 70 years. Low dose short synacthen test (1 μg ACTH), standard dose short synacthen test (250 μg ACTH) and glucagon tests were performed consecutively. The mean peak cortisol response to standard dose ACTH stimulation test was found to be significantly higher than the low dose ACTH and glucagon stimulation tests. The mean peak cortisol responses to low dose ACTH and the glucagon stimulation tests were not significantly different. The mean peak cortisol responses did not differ significantly between different age or sex groups. The lowest peak cortisol responses obtained after low dose ACTH and glucagon stimulation tests were 12.5 and 9.1 μg/dl respectively in the volunteers who all had cortisol responses higher than 20 μg/dl after standard dose ACTH stimulation test. The lowest cortisol responses obtained during 250 μg ACTH, 1 μg ACTH and glucagon stimulation tests were found to be 20.1, 12.5 and 9.1 μg/dl in a known group of healthy people. So the consideration of appropriate hormonal cut-off levels for each test seems reasonable. The age, sex and body mass indeces were not shown to affect the cortisol response to dynamic stimulation tests.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Fig. 1
Fig. 2
Fig. 3

Similar content being viewed by others

References

  1. Fish HR, Chernow B, O’Brian JT (1986) Endocrine and neurophysiologic responses of the pituitary to insulin-induced hypoglycemia: a review. Metabolism 35:763–780

    Article  CAS  PubMed  Google Scholar 

  2. Grinspoon SK, Biller BM (1994) Clinical review 62: laboratory assessment of adrenal insufficiency. J Clin Endocrinol Metab 79:923–931

    CAS  PubMed  Google Scholar 

  3. Plumpton FS, Besser GM (1969) The adrenocortical response to surgery and insulin-induced hypoglycaemia in corticosteroid-treated and normal subjects. Br J Surg 56:216–219

    Article  CAS  PubMed  Google Scholar 

  4. Hurel SJ, Thompson CJ, Watson MJ, Harris MM, Baylis PH, Kendall-Taylor P (1996) The short Synacthen and insulin stress tests in the assessment of the hypothalamic-pituitary-adrenal axis. Clin Endocrinol 44:141–146

    Article  CAS  Google Scholar 

  5. Lindholm J, Kehlet H, Blichert-Toft M, Dinesen B, Riishede J (1978) Reliability of the 30-minute ACTH test in assessing hypothalamic-pituitary-adrenal function. J Clin Endocrinol Metab 47:272–274

    Article  CAS  PubMed  Google Scholar 

  6. Daidoh H, Morita H, Mune T, Murayama M, Hanafusa J, Ni H, Shibata H, Yasuda K (1995) Responses of plasma adrenocortical steroids to low dose ACTH in normal subjects. Clin Endocrinol 43:311–315

    Article  CAS  Google Scholar 

  7. Dickstein G, Shechner C, Nicholson WE, Rosner I, Shen-Orr Z, Adawi F, Lahav M (1991) 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

    Article  CAS  PubMed  Google Scholar 

  8. Dokmetas HS, Colak R, Kelestimur F, Selcuklu A, Unluhizarci K, Bayram F (2000) A comparison between the 1-microg adrenocorticotropin (ACTH) test, the short ACTH (250 microg) test, and the insulin tolerance test in the assessment of hypothalamo-pituitary-adrenal axis immediately after pituitary surgery. J Clin Endocrinol Metab 85:3713–3719

    CAS  PubMed  Google Scholar 

  9. Giordano R, Picu A, Bonelli L, Balbo M, Berardelli R, Marinazzo E, Corneli G, Ghigo E, Arvat E (2008) Hypothalamus-pituitary-adrenal axis evaluation in patients with hypothalamo-pituitary disorders: comparison of different provocative tests. Clin Endocrinol 68:935–941

    Article  CAS  Google Scholar 

  10. Leong KS, Walker AB, Martin I, Wile D, Wilding J, MacFarlane IA (2001) An audit of 500 subcutaneous glucagon stimulation tests to assess growth hormone and ACTH secretion in patients with hypothalamic-pituitary disease. Clin Endocrinol 54:463–468

    Article  CAS  Google Scholar 

  11. Kappy MS, Drake A, Gao D, Ratliff R (2006) Assessing adrenal function in primary care settings with a single sample subcutaneous glucagon test. J Pediatr 149:682–686

    Article  CAS  PubMed  Google Scholar 

  12. Reynolds RM, Stewart PM, Seckl JR, Padfield PL (2006) Assessing the HPA axis in patients with pituitary disease: a UK survey. Clin Endocrinol 64:82–85

    Article  Google Scholar 

  13. May ME, Carey RM (1985) Rapid adrenocorticotropic hormone test in practice. Retrospective review. Am J Med 79:679–684

    Article  CAS  PubMed  Google Scholar 

  14. Schultz CH, Rivers EP, Feldkamp CS, Goad EG, Smithline HA, Martin GB, Fath JJ, Wortsman J, Nowak RM (1993) A characterization of hypothalamic-pituitary-adrenal axis function during and after human cardiac arrest. Crit Care Med 21:1339–1347

    Article  CAS  PubMed  Google Scholar 

  15. Ammari F, Issa BG, Millward E, Scanion MF (1996) A comparison between short ACTH and insulin stress tests for assessing hypothalamo-pituitary-adrenal function. Clin Endocrinol 44:473–476

    Article  CAS  Google Scholar 

  16. Rasmuson S, Olsson T, Hagg E (1996) A low dose ACTH test to assess the function of the hypothalamic-pituitary-adrenal axis. Clin Endocrinol 44:151–156

    Article  CAS  Google Scholar 

  17. Kazlauskaite R, Evans AT, Villabona CV, Abdu TA, Ambrosi B, Atkinson AB, Choi CH, Clayton RN, Courtney CH, Gonc EN, Maghnie M, Rose SR, Soule SG, Tordjman K, Consortium for Evaluation of Corticotropin Test in Hypothalamic-Pituitary Adrenal Insufficiency (2008) Corticotropin tests for hypothalamic-pituitary- adrenal insufficiency: a metaanalysis. J Clin Endocrinol Metab 93:4245–4253

    Article  CAS  PubMed  Google Scholar 

  18. Kelestimur F, Akgun A, Gunay O (1995) A comparison between short synacthen test and depot synacthen test in the evaluation of cortisol reserve of adrenal gland in normal subjects. J Endocrinol Invest 18:823–826

    Article  CAS  PubMed  Google Scholar 

  19. Kukreja SC, Williams GA (1981) Corticotrophin stimulation test: inverse correlation between basal serum cortisol and its response to corticotrophin. Acta Endocrinol 97:522–524

    CAS  PubMed  Google Scholar 

  20. Kelestimur F, Unlu Y, Ozesmi M, Tolu I (1994) A hormonal and radiological evaluation of adrenal gland in patients with acute or chronic pulmonary tuberculosis. Clin Endocrinol 41:53–56

    Article  CAS  Google Scholar 

  21. Abdu TA, Elhadd TA, Neary R, Clayton RN (1999) 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

    CAS  PubMed  Google Scholar 

  22. Tordjman K, Jaffe A, Grazas N, Apter C, Stern N (1995) 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

    CAS  PubMed  Google Scholar 

  23. Littley MD, Gibson S, White A, Shalet SM (1989) Comparison of the ACTH and cortisol responses to provocative testing with glucagon and insulin hypoglycaemia in normal subjects. Clin Endocrinol 31:527–533

    Article  CAS  Google Scholar 

  24. Tanriverdi F, Unluhizarci K, Coksevim B, Selcuklu A, Casanueva FF, Kelestimur F (2007) Kickboxing sport as a new cause of traumatic brain injury-mediated hypopituitarism. Clin Endocrinol 66:360–366

    Article  Google Scholar 

  25. Berg C, Meinel T, Lahner H, Yuece A, Mann K, Petersenn S (2010) Diagnostic utility of the glucagon stimulation test in comparison to the insulin tolerance test in patients following pituitary surgery. Eur J Endocrinol 162:477–482

    Article  CAS  PubMed  Google Scholar 

Download references

Acknowledgments

Grant support By Erciyes University Council of Scientific Investigations (project code: TST-07-38).

Conflicts of interest

None

Author information

Authors and Affiliations

  1. Department of Endocrinology, Erciyes University Medical School, 38039, Kayseri, Turkey

    Zuleyha Karaca, Ayhan Lale, Fatih Tanriverdi, Kursad Unluhizarci & Fahrettin Kelestimur

  2. Department of Nucleer Medicine, Erciyes University Medical School, Kayseri, Turkey

    Mustafa Kula

Authors
  1. Zuleyha Karaca
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Ayhan Lale
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Fatih Tanriverdi
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. Mustafa Kula
    View author publications

    You can also search for this author in PubMed Google Scholar

  5. Kursad Unluhizarci
    View author publications

    You can also search for this author in PubMed Google Scholar

  6. Fahrettin Kelestimur
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Fahrettin Kelestimur.

Rights and permissions

Reprints and permissions

About this article

Cite this article

Karaca, Z., Lale, A., Tanriverdi, F. et al. The comparison of low and standard dose ACTH and glucagon stimulation tests in the evaluation of hypothalamo-pituitary-adrenal axis in healthy adults. Pituitary 14, 134–140 (2011). https://doi.org/10.1007/s11102-010-0270-3

Download citation

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s11102-010-0270-3

Keywords

Search

Navigation