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A subnormal peak cortisol response to stimulation testing does not predict a subnormal cortisol production rate.
A N Paisley1, S V Rowles, D Brandon
1Department of Endocrinology, Christie Hospital, Manchester M20 4BX, United Kingdom.
The Journal of Clinical Endocrinology and Metabolism
|February 26, 2009
Summary
A suboptimal peak cortisol response to hypoglycemia does not automatically mean a low cortisol production rate (CPR). These findings suggest that lifelong glucocorticoid replacement therapy should not be initiated solely based on these provocative tests.
Area of Science:
- Endocrinology
- Metabolic Disorders
- Hormone Replacement Therapy
Background:
- Lifelong glucocorticoid replacement therapy decisions often rely on cortisol stimulation tests.
- The accuracy of provocative tests in guiding glucocorticoid initiation needs further investigation.
Purpose of the Study:
- To investigate the relationship between peak cortisol response during insulin-induced hypoglycemia and daily cortisol production rate (CPR).
- To determine if provocative tests accurately indicate the need for lifelong glucocorticoid replacement therapy.
Main Methods:
- Ten patients with pituitary disease and suboptimal peak cortisol response underwent CPR measurement using isotope dilution and gas chromatography-mass spectrometry.
- 24-hour urinary free cortisol (UFC) was also measured.
Main Results:
- A strong positive correlation (r = 0.75; P = 0.02) was observed between peak stimulated cortisol and CPR.
- All patients had CPR within or above the reference range, despite suboptimal peak cortisol response.
- 24-hour UFC showed no significant correlation with serum cortisol or CPR.
Conclusions:
- This study demonstrates a significant correlation between CPR and peak cortisol during hypoglycemic challenge.
- A suboptimal peak cortisol response does not necessarily indicate a low CPR and should not automatically trigger lifelong glucocorticoid replacement.
- Urinary free cortisol (UFC) is unhelpful in assessing these patients.
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