ECE2014 Poster Presentations Pituitary Clinical (<emphasis role="italic">Generously supported by IPSEN</emphasis>) (108 abstracts)
Cortisol metabolites response in hypothalamic–pituitary–adrenal axis tests
Katerina Simunkova 1 , Michaela Duskova 2 , Michal Krsek 1 , Vaclav Hana 1 , Martin Hill 2 , Mikulas Kosak 1 , Hana Jandikova 2 , Hana Pospisilova 2 & Luboslav Starka 2
1Third Department of Intenal Medicine, First Faculty of Medicine and General Teaching Hospital, Prague, Czech Republic; 2Institute of Endocrinology, Prague, Czech Republic.
The aim of the study was a detailed analysis and a comparison of hypothalamic–pituitary–adrenal axis tests and cortisol metabolites analysis during these tests. This procedure might enable to design new diagnosis algorithms of hypocorticalism and normal levels for salivary cortisol estimation for early diagnostic of patients with hypothalamic–pituitary–adrenal axis disorder as well as to give us a possibility to reveal adrenal disorder in patients on estrogen therapy or with altered levels of cortisol-binding proteins whose hypothalamic–pituitary–adrenal axis evaluation is always problematic.
Sixty healthy volunteers (age 38±10 year (mean ±S.D.), BMI 24.5±2.7 kg/cm2) were examined by high (250 μg), low dose (1 μg) and 10 μg synacthen test and insulin test (ITT). The study was approved by the local Ethical Committee.
We evaluated serum cortisol, serum cortisone, salivary cortisol, steroids in Δ4 pathway, other steroids and their polar conjugates in Δ4 and Δ5 pathway: reduced 5α/β-metabolites of cortisol during dynamic tests, and basal levels of cortisol binding globulin, aldosterone and ACTH respectively.
All subjects reached the normal response of cortisol (>500 nmol/l) in all tests. The levels of cortisol metabolites were significantly lower in 1 μg synacthen test comparing to remaining tests and the peak was observed at the 60 min after the stimulation. The levels of salivary cortisol were significantly higher 45±4.5 nmol/l in the 250 μg and ITT compared to low and 10 μg synacthen test, 37±2.5 nmol/l.
Conclusion: Four different hypothalamic–pituitary–adrenal axis tests gave similar response of cortisol, however, the response of cortisol metabolites is lower in the low dose synacthen test. These results may contribute to better understanding the pathophysiology of changes in hypothalamic–pituitary–adrenal axis disorders.
The study was supported by grant No. NT11 277-6 of the IGA MZCR.
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Endocrine Abstracts
ISSN 1470-3947 (print) | ISSN 1479-6848 (online)
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