Diagnosis and therapy surveillance in Addison's disease: rapid adrenocorticotropin (ACTH) test and measurement of plasma ACTH, renin activity, and aldosterone
Abstract
The rapid ACTH injection test is an indirect screening test for adrenocortical insufficiency. As a supplement to this test, we evaluated the practicability of single measurements of plasma cortisol, ACTH, aldosterone, and PRA as a definitive diagnostic test of primary adrenocortical insufficiency (PAI). We also tested the value of PRA measurements during treatment with hydro- and fludrocortisone (HC and FC) as a guide for correct mineralocorticoid substitution. In 45 patients with PAI, results of the rapid ACTH test and single measurements of the four hormones (all tests between 0800-0900 h) were compared. Single hormone measurements were also made in 55 normal subjects and 46 patients with pituitary disease (cortisol and ACTH only), most of them with mild to severe secondary adrenocortical insufficiency (SAI). The rapid ACTH test was abnormal in 100% of 41 patients with PAI tested. Plasma ACTH, PRA, and the ratios of ACTH/cortisol and PRA/plasma or urinary aldosterone were clearly elevated in 100% of the patients with PAI. The ACTH/cortisol ratio also distinguished 100% of patients with PAI from those with SAI, but not always control subjects from those with SAI. Thus, dynamic tests (CRH or insulin tests) are indicated if SAI is suspected. PAI and involvement of zona fasciculata and glomerulosa function can be diagnosed with high reliability by measuring cortisol, ACTH, aldosterone, and PRA either together with the rapid ACTH test or later, after a short interval of steroid…
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Confirmatory cosyntropin testing can be performed after treatment, with temporary cessation of glucocorticoid when the patient's condition is stable.
“Confirmatory cosyntropin testing can be performed after treatment, with temporary cessation of glucocorticoid when the patient's condition is stable (38,39).”
From Diagnosis and Treatment of Primary Adrenal Insufficiency: An Endocrine Society Clinical Practice Guideline (2016) · cites this paper as [38]
The corticotropin stimulation test is a superior diagnostic test with higher sensitivity and specificity than morning cortisol and ACTH for diagnosing PAI.
“Although it is more elaborate and requires endocrinological expertise, the corticotropin stimulation test is a superior diagnostic test with a higher degree of sensitivity and specificity than determination of morning cortisol and ACTH concentrations and is therefore preferred in all patients considered with the differential diagnosis of PAI (28,38).”
From Diagnosis and Treatment of Primary Adrenal Insufficiency: An Endocrine Society Clinical Practice Guideline (2016) · cites this paper as [38]
An elevated plasma renin activity or concentration with an inappropriately normal or low serum aldosterone concentration is suggestive of PAI.
“Thus, an elevated plasma renin activity or concentration in combination with an (inappropriately) normal or low serum aldosterone concentration is suggestive of PAI (38,(71)(72)(73)(74).”
From Diagnosis and Treatment of Primary Adrenal Insufficiency: An Endocrine Society Clinical Practice Guideline (2016) · cites this paper as [38]
Plasma renin activity in the upper reference range is a useful marker for a correct mineralocorticoid dose.
“Furthermore, plasma renin activity in the upper reference range has been found to be a useful marker for a correct mineralocorticoid dose (38,107,108).”
From Diagnosis and Treatment of Primary Adrenal Insufficiency: An Endocrine Society Clinical Practice Guideline (2016) · cites this paper as [38]
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“Furthermore, plasma renin activity in the upper reference range has been found to be a useful marker for a correct mineralocorticoid dose (38, 107, 108).”
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- Authors
- Oelkers, W., Diederich, S., & Bähr, V
- Affiliations
- Freie Universität Berlin (DE)
- ORCID
- Diederich, S
- Venue
- The Journal of Clinical Endocrinology & Metabolism
- Publisher
- The Endocrine Society
- Published
- 1992-07
- Volume
- 75
- Issue
- 1
- Pages
- 259-264
- ISSN
- 0021-972X (ISSN-L)
- 1945-7197
- OpenAlex
- W2090175399
- Cited by
- 193
- References
- 2
- Citations by year
- 2026: 2 · 2025: 2 · 2024: 5 · 2023: 7 · 2022: 6 · 2021: 5 · 2020: 7 · 2019: 6 · 2018: 4 · 2017: 8 · 2016: 5 · 2015: 8 · 2014: 18 · 2013: 9 · 2012: 6
- FWCI
- 1.41
- Type
- journal article
- Language
- en
- Open access
- closed
- Locations
- The Journal of Clinical Endocrinology & Metabolism (publishedVersion)
- PubMed (publishedVersion)
- Topics
- Health Sciences › Medicine › Endocrinology, Diabetes and Metabolism › Adrenal Hormones and Disorders
- Health Sciences › Medicine › Endocrinology, Diabetes and Metabolism › Hormonal Regulation and Hypertension
- Life Sciences › Neuroscience › Behavioral Neuroscience › Stress Responses and Cortisol
- Keywords
- Addison's disease, plasma ACTH, renin activity, aldosterone, cortisol, fludrocortisone, mineralocorticoid replacement, treatment titration, pituitary disorders
- MeSH terms
- Addison Disease, Adrenal Cortex, Adrenocorticotropic Hormone, Aldosterone, Female, Fludrocortisone, Humans, Hydrocortisone, Male, Potassium, Renin, Sodium
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