{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,3,28]],"date-time":"2026-03-28T08:31:57Z","timestamp":1774686717485,"version":"3.50.1"},"reference-count":32,"publisher":"Wiley","issue":"2","license":[{"start":{"date-parts":[[2001,12,24]],"date-time":"2001-12-24T00:00:00Z","timestamp":1009152000000},"content-version":"vor","delay-in-days":510,"URL":"http:\/\/onlinelibrary.wiley.com\/termsAndConditions#vor"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["Clinical Endocrinology"],"published-print":{"date-parts":[[2000,8]]},"abstract":"<jats:sec><jats:title>OBJECTIVE<\/jats:title><jats:p>The 1\u2003\u03bcg ACTH stimulation test has been advocated as a sensitive indicator of the integrity of the hypothalamic\u2013pituitary\u2013adrenal axis in patients with suspected hypopituitarism. The aim of our study was to define the normal response to 1\u2003\u03bcg ACTH stimulation in a control population and to study the sensitivity and specificity of the test in a group of patients with suspected pituitary disease.<\/jats:p><\/jats:sec><jats:sec><jats:title>DESIGN<\/jats:title><jats:p>A prospective analysis of the performance of the 1\u2003\u03bcg ACTH stimulation test in a group of patients with pituitary disease.<\/jats:p><\/jats:sec><jats:sec><jats:title>PATIENTS<\/jats:title><jats:p>The cortisol response to 1\u2003\u03bcg ACTH was evaluated in 21 normal subjects and 65 patients with pituitary disease. The patients with pituitary disease were divided into two groups according to the 11\u2010deoxycortisol response to overnight metyrapone: normal (11\u2010deoxycortisol &gt;\u2003200\u2003nmol\/l) and subnormal ACTH secretory status (11\u2010deoxycortisol &lt;\u2003200\u2003nmol\/l).<\/jats:p><\/jats:sec><jats:sec><jats:title>MEASUREMENTS<\/jats:title><jats:p>In both controls and patients, blood was sampled for cortisol at \u2212\u200315, 0, +\u200320, +\u200330, +\u200340 and +\u200360\u2003minutes after intravenous administration of 1\u2003\u03bcg synthetic ACTH (Synacthen<jats:sup>\u00ae<\/jats:sup>). The overnight metyrapone test was performed only in the subjects with pituitary disease. Metyrapone (30\u2003mg\/kg) was administered orally at 2300\u2003h and blood was sampled at 0830\u2003h the following morning for 11\u2010deoxycortisol.<\/jats:p><\/jats:sec><jats:sec><jats:title>RESULTS<\/jats:title><jats:p>The 65 patients with pituitary disease were categorized according to the 11\u2010deoxycortisol response to metyrapone as follows: 53 normal (11\u2010deoxycortisol &gt;\u2003200\u2003nmol\/l) and 12 subnormal (&lt;\u2003200\u2003nmol\/l). The 12 patients who failed the metyrapone test had a significantly impaired cortisol response to low dose ACTH stimulation at all time points when compared with both the control group and the pituitary patients with a normal response to metyrapone (<jats:italic>P\u2003<\/jats:italic>&lt;\u20030.001). Comparing the pituitary patients who had a normal response to metyrapone and the control subjects, there was no significant difference in the cortisol response to ACTH (<jats:italic>P\u2003<\/jats:italic>&gt;\u20030.05). The minimum cortisol response at 30\u2003minutes in the 21 control subjects was 414\u2003nmol\/l and this was defined as the minimum normal cortisol response to 1\u2003\u03bcg ACTH. Using this criterion, six of the 12 patients with a subnormal response to metyrapone had a normal cortisol response to low dose ACTH stimulation. Empirically increasing the cortisol cut\u2010off to 600\u2003nmol\/l increased the sensitivity of the low dose ACTH test to 83%, although the specificity was reduced from 100% to only 58%.<\/jats:p><\/jats:sec><jats:sec><jats:title>CONCLUSIONS<\/jats:title><jats:p>The normal cortisol response to low dose ACTH stimulation in 50% of the patients with ACTH deficiency proven on metyrapone testing suggests that the 1\u2003\u03bcg ACTH stimulation test, like the 250\u2003\u03bcg\u2010test, lacks sensitivity for the diagnosis of ACTH deficiency.<\/jats:p><\/jats:sec>","DOI":"10.1046\/j.1365-2265.2000.01057.x","type":"journal-article","created":{"date-parts":[[2003,3,11]],"date-time":"2003-03-11T10:45:55Z","timestamp":1047379555000},"page":"221-227","source":"Crossref","is-referenced-by-count":47,"title":["The low dose ACTH stimulation test is less sensitive than the overnight metyrapone test for the diagnosis of secondary 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