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ID 117738
Title Alternative
Treatment algorithm of ACTH deficiency
Author
Mitsui, Yukari Tokushima University
Iizuka, Yuto Tokushima University
Tanaka, Tomoaki Tokushima University
Masuda, Shiho Tokushima University
Ohnishi, Yukiyo Tokushima University
Kondo, Takeshi Tokushima Red Cross Hospital KAKEN Search Researchers
Kanezaki, Toshiko Tokushima Red Cross Hospital
Shintani, Yasumi Tokushima Red Cross Hospital
Yamaguchi, Yuki Tokushima Prefecture Naruto Hospital
Fujinaka, Yuichi Tokushima Prefecture Naruto Hospital
Morimoto, Kana Tokushima Prefectural Central Hospital
Shirakami, Atsuhisa Tokushima Prefectural Central Hospital
Keywords
central adrenal insufficiency
corticotropin-releasing hormone (CRH) test
dehydroepiandrosterone-sulfate (DHEA-S)
retrospective cohort study
treatment algorithm
Content Type
Journal Article
Description
Objective : To examine diagnostic performance of corticotropin-releasing hormone (CRH) test combined with baseline dehydroepiandrosterone sulfate (DHEA-S) in patients with a suspect of central adrenal insufficiency. Methods : Patients (n=215) requiring daily or intermittent hydrocortisone replacement, or no replacement were retrospectively checked with their peak cortisol after CRH test and baseline DHEA-S. Results : None of 106 patients with the peak cortisol ≥ 17.5 μg / dL after CRH test required replacement, and all 64 patients with the peak cortisol < 10.0 μg / dL required daily replacement. Among 8 patients with 10.0 μg / dL ≤ the peak cortisol < 17.5 μg / dL and baseline DHEA-S below the reference range, 6 patients required daily replacement and 1 patient was under intermittent replacement. Among 37 patients with 10.0 μg / dL ≤ the peak cortisol < 17.5 μg / dL and baseline DHEA-S within the reference range, 10 and 6 patients were under intermittent and daily replacement, respectively. Conclusions : No patients with the peak cortisol ≥ 17.5 μg / dL required hydrocortisone replacement, and all patients with the peak cortisol below 10.0 μg / dL required daily replacement. Careful clinical evaluation was required to determine requirement for replacement in patients with 10.0 μg / dL ≤ the peak cortisol < 17.5 μg / dL even in combination with baseline DHEA-S.
Journal Title
The Journal of Medical Investigation
ISSN
13496867
13431420
NCID
AA11166929
Publisher
Tokushima University Faculty of Medicine
Volume
69
Issue
3-4
Start Page
287
End Page
293
Sort Key
287
Published Date
2022-08
EDB ID
DOI (Published Version)
URL ( Publisher's Version )
FullText File
language
eng
TextVersion
Publisher
departments
Medical Sciences
University Hospital
Institute of Advanced Medical Sciences