PDF(Pubmed)
Abstract：
UNASSIGNED: As synacthen use is not licensed in India and there are concerns about the safety of the insulin tolerance test (ITT), an alternative dynamic test to diagnose adrenal insufficiency (AI) is required.
UNASSIGNED: The study aimed to evaluate the diagnostic performance of the Acton Prolongatum stimulation test (APST) with a standard ITT for the diagnosis of AI.
UNASSIGNED: Prospective study comparing two diagnostic tests.
UNASSIGNED: Six healthy volunteers and 53 suspected or known AI patients.
UNASSIGNED: Serum cortisol response to ITT and APST.
UNASSIGNED: The median (95% confidence interval [CI]) peak cortisol levels among healthy volunteers in ITT and APST were 17 (14.58-19.08) and 30.5 (22.57-34.5) μg/dL. Of the 53 patients (age: 39.6 ± 9.38 years; females: 38 [71.1%]), 34 had AI (peak ITT serum cortisol < 14.5 μg/dL) whereas 19 had a normal hypothalamic-pituitary-adrenocortical (HPA) axis. In the receiver operator characteristic curve analysis, 60-min APST cortisol had an area under the curve of 0.984 (95% CI: 0.904-1.00, P < 0.0001). The best accuracy was obtained at a cut-off of 16.42 μg/dL (sensitivity: 97.7% [95% CI: 87.7-99.9%]; specificity: 100% [69.2-100%]). Forty-three of the 53 patients with suspected AI had hypoglycemic symptoms during ITT and two of them required intravenous dextrose, whereas, none had adverse events during APST. The ITT was incomplete in two patients whereas all completed APST.
UNASSIGNED: APST is a simple, safe, and reliable alternative to ITT for the diagnosis of AI; 60-min serum cortisol of 16.42 μg/dL in APST best distinguishes the AI patients from those with adequate cortisol response.
UNASSIGNED: The study aimed to evaluate the diagnostic performance of the Acton Prolongatum stimulation test (APST) with a standard ITT for the diagnosis of AI.
UNASSIGNED: Prospective study comparing two diagnostic tests.
UNASSIGNED: Six healthy volunteers and 53 suspected or known AI patients.
UNASSIGNED: Serum cortisol response to ITT and APST.
UNASSIGNED: The median (95% confidence interval [CI]) peak cortisol levels among healthy volunteers in ITT and APST were 17 (14.58-19.08) and 30.5 (22.57-34.5) μg/dL. Of the 53 patients (age: 39.6 ± 9.38 years; females: 38 [71.1%]), 34 had AI (peak ITT serum cortisol < 14.5 μg/dL) whereas 19 had a normal hypothalamic-pituitary-adrenocortical (HPA) axis. In the receiver operator characteristic curve analysis, 60-min APST cortisol had an area under the curve of 0.984 (95% CI: 0.904-1.00, P < 0.0001). The best accuracy was obtained at a cut-off of 16.42 μg/dL (sensitivity: 97.7% [95% CI: 87.7-99.9%]; specificity: 100% [69.2-100%]). Forty-three of the 53 patients with suspected AI had hypoglycemic symptoms during ITT and two of them required intravenous dextrose, whereas, none had adverse events during APST. The ITT was incomplete in two patients whereas all completed APST.
UNASSIGNED: APST is a simple, safe, and reliable alternative to ITT for the diagnosis of AI; 60-min serum cortisol of 16.42 μg/dL in APST best distinguishes the AI patients from those with adequate cortisol response.
摘要：
■由于在印度没有许可使用synacthen，并且对胰岛素耐量测试（ITT）的安全性存在担忧，需要另一种动态试验来诊断肾上腺功能不全(AI).
■该研究旨在评估具有用于AI诊断的标准ITT的ActonProlongatum刺激测试（APST）的诊断性能。
■比较两种诊断测试的前瞻性研究。
■6名健康志愿者和53名疑似或已知的AI患者。
■血清皮质醇对ITT和APST的反应。
■ITT和APST健康志愿者皮质醇峰值水平的中位数（95％置信区间[CI]）分别为17（14.58-19.08）和30.5（22.57-34.5）μg/dL。在53例患者中（年龄：39.6±9.38岁；女性：38[71.1％]），34人的AI（ITT血清皮质醇峰值<14.5μg/dL），而19人的下丘脑-垂体-肾上腺皮质（HPA）轴正常。在接收机算子特征曲线分析中,60分钟APST皮质醇的曲线下面积为0.984（95％CI：0.904-1.00，P<0.0001）。在16.42μg/dL的截止值下获得最佳准确性（灵敏度：97.7%[95%CI：87.7-99.9%]；特异性：100%[69.2-100%]）。53例疑似AI患者中43例在ITT期间出现低血糖症状,其中2例需要静脉注射葡萄糖,然而,APST期间没有发生不良事件。两名患者的ITT不完整，而所有患者均完成了APST。
■APST是一个简单的，安全,ITT诊断AI的可靠替代方法；APST中60分钟的血清皮质醇为16.42μg/dL，最能区分AI患者与皮质醇反应充分的患者。
■该研究旨在评估具有用于AI诊断的标准ITT的ActonProlongatum刺激测试（APST）的诊断性能。
■比较两种诊断测试的前瞻性研究。
■6名健康志愿者和53名疑似或已知的AI患者。
■血清皮质醇对ITT和APST的反应。
■ITT和APST健康志愿者皮质醇峰值水平的中位数（95％置信区间[CI]）分别为17（14.58-19.08）和30.5（22.57-34.5）μg/dL。在53例患者中（年龄：39.6±9.38岁；女性：38[71.1％]），34人的AI（ITT血清皮质醇峰值<14.5μg/dL），而19人的下丘脑-垂体-肾上腺皮质（HPA）轴正常。在接收机算子特征曲线分析中,60分钟APST皮质醇的曲线下面积为0.984（95％CI：0.904-1.00，P<0.0001）。在16.42μg/dL的截止值下获得最佳准确性（灵敏度：97.7%[95%CI：87.7-99.9%]；特异性：100%[69.2-100%]）。53例疑似AI患者中43例在ITT期间出现低血糖症状,其中2例需要静脉注射葡萄糖,然而,APST期间没有发生不良事件。两名患者的ITT不完整，而所有患者均完成了APST。
■APST是一个简单的，安全,ITT诊断AI的可靠替代方法；APST中60分钟的血清皮质醇为16.42μg/dL，最能区分AI患者与皮质醇反应充分的患者。
