Comparison of 17-OH progesterone response to various dose of tetracosactide

Mikulas Kosak; Michaela Duskova; Katerina Simunkova; Vaclav Hana; Michal Krsek; Hana Jandikova; Hana Pospisilova; Monika Sramkova; Marta Velikova; Luboslav Starka

doi:10.1530/endoabs.37.EP51

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Endocrine Abstracts (2015) 37 EP51 | DOI: 10.1530/endoabs.37.EP51

ECE2015 Eposter Presentations Adrenal cortex (94 abstracts)

Comparison of 17-OH progesterone response to various dose of tetracosactide

Mikuláš Kosák ¹ , Michaela Duškova ² , Katerina Šimunková ^1, , Václav Hána ¹ , Michal Kršek ¹ , Hana Jandíková ² , Hana Pospíšilová ² , Monika Šrámková ² , Marta Velíková ² & Luboslav Stárka ²

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¹3rd Department of Medicine, General University Hospital and First Faculty of Medicine, Charles University, Prague, Czech Republic; ²Institute of Endocrinology, Prague, Czech Republic.

ACTH test is widely accepted as diagnostic tool in suspicion on peripheral as well as on central hypocorticism. The optimal dose of tetracosactide for determination of hypocorticism is still matter of debate. The 250 μg as a standard dose of tetracosactide has been approved for diagnosis of congenital adrenal hyperplasia (CAH) many years ago. Moreover, current limited availability of tetracosactide and its increased financial cost on the market raised the question whether the lower dose of tetracosactide for diagnosis of CAH may be sufficient stimulation.

Aims: To compare response of 17-OH progesterone (17-OHP) to various doses of tetracosactide in healthy volunteers.

Methods: In ten healthy volunteers (four males, median 42 years) with normal adrenal function (based on clinical and biochemical evaluation) the ACTH tests with i.v. administration of 250 μg (HDST), 10 μg (MDST), and 1 μg (LDST) tetracosactide were performed.

Results: Similar response in 17-OHP levels in all three variants of the test was observed. Median 17-OHP levels 30 min after the tetracosactide administration were 6.62, 6.62, and 5.68 nmol/l for HDST, MDST, and LDST respectively. 60 min after the administration the median levels were 6.93, 5.91, and 4.70 nmol/l.

Conclusion: Our data support the hypothesis of ACTH test reliability for the diagnosis of CAH in all variants with lower doses of ACTH compared to standard dose. Further confirmation of our observation in patients with known non-classical form of CAH would be appropriate.

Disclosure: This work was supported by grant number NT 11277-6 of the IGA MZCR.