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Variable Sensitivity to the Glucocorticoid Activity of Cortisol in Patients with Primary Adrenal Insufficiency: Assessment with ACTH Profiles
Linköping University, Department of Medical and Health Sciences, Internal Medicine. Linköping University, Faculty of Health Sciences. Östergötlands Läns Landsting, Centre for Medicine, Department of Endocrinology and Gastroenterology UHL.
Internal Medicine County Hospital, Eksjö, Sweden.
Internal Medicine County Hospital, Eksjö, Sweden.
Internal Medicine County Hospital, Kalmar, Sweden.
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2010 (English)In: Hormone and Metabolic Research, ISSN 0018-5043, E-ISSN 1439-4286, Vol. 42, no 13, 961-966 p.Article in journal (Refereed) Published
Abstract [en]

Our aim was to investigate the usefulness of circulating levels of adrenocorticotropic hormone (ACTH) and also salivary cortisol to monitor cortisone substitution in patients with Addisons disease. 13 patients with primary adrenal insufficiency (8 women and 5 men, age 44 +/- 11 years) received 12.5 mg cortisone acetate orally at 16:00 h and 25 mg at 07:00 h. Blood samples for cortisol and ACTH analysis were drawn every hour for 24 h, and also every half hour between 07:00 and 12:00 h. Samples for salivary cortisol were collected in parallel. Total ACTH levels showed large inter-individual variations and a diurnal rhythm with a nadir in the early evening at 19:00 (median 19 ng/l, range 2-434 ng/l) and high levels in the early morning, with a peak around 07:30 (median 844 ng/l, range 45-2 249 ng/l). Plasma cortisol concentrations showed 2 peaks distinct in time, but variable in height, 1-2 h after intake of cortisone. Plasma cortisol correlated significantly with ln(ACTH) at 17:00 h (r = -0.56), at 10:00 h (r = -0.51), and at 10.30 h (r = -0.57). When tested at different time points, ln(ACTH) at 10:00 to 12:00 h was negatively correlated with plasma cortisol between 08:30 and 12:00 h. Plasma cortisol was highly correlated to ln(salivary cortisol) most of the time points measured, but 30-60 min after intake of cortisone acetate the correlation disappeared. In conclusion, the large interindividual variation in ACTH levels most likely indicates varying sensitivity to cortisol with a need for individualized dosing schemes. Furthermore ACTH-determinations may be useful for dose titration of cortisol.

Place, publisher, year, edition, pages
Georg Thieme Verlag , 2010. Vol. 42, no 13, 961-966 p.
Keyword [en]
cortisol; cortisone; ACTH; adrenal insufficiency
National Category
Medical and Health Sciences
URN: urn:nbn:se:liu:diva-63962DOI: 10.1055/s-0030-1265218ISI: 000284941500010OAI: diva2:384480
Available from: 2011-01-10 Created: 2011-01-10 Last updated: 2014-01-14

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Ekman, BertilArnqvist, Hans
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Internal MedicineFaculty of Health SciencesDepartment of Endocrinology and Gastroenterology UHLCell Biology
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