Related Experiment Video
Updated: Jun 24, 2026
08:02
Fecal Glucocorticoid Analysis: Non-invasive Adrenal Monitoring in Equids
Published on: April 25, 2016
Adrenocorticotropic hormone stimulation test during high-dose glucocorticoid therapy
Carmen V Villabona1, Chung Koh, Jessel Panergo
1Division of Endocrinology, Rush University Medical Center, Chicago, Illinois, USA.
Summary
The short adrenocorticotropic hormone stimulation test (ACTH-ST) can diagnose adrenal insufficiency within 72 hours of starting high-dose glucocorticoid therapy. A suppressed cortisol response after 72 hours may indicate adrenal insufficiency.
Area of Science:
- Endocrinology
- Pharmacology
Background:
- High-dose glucocorticoid therapy can suppress the hypothalamic-pituitary-adrenal axis.
- Accurate diagnosis of adrenal insufficiency is crucial, especially during glucocorticoid treatment.
Purpose of the Study:
- To determine the effective time frame for the adrenocorticotropic hormone stimulation test (ACTH-ST) to accurately diagnose adrenal insufficiency after initiating high-dose glucocorticoid therapy.
Main Methods:
- Hospitalized patients with intact hypothalamic-pituitary-adrenal axes receiving high-dose dexamethasone underwent ACTH-ST at 24, 48, 72, and 96 hours.
- Serum cortisol levels were measured at 0, 30, and 60 minutes post-cosyntropin administration.
Main Results:
- All 8 patients tested within 72 hours showed adequate cortisol response (≥18 µg/dL at 60 minutes).
- Two of 3 patients tested at 96 hours had suppressed cortisol response at 60 minutes.
- Cortisol levels at 30 minutes were inadequate in all but one patient.
Conclusions:
- The ACTH-ST may be a reliable diagnostic tool for adrenal insufficiency within the first 3 days of empiric glucocorticoid therapy.
- A suppressed serum cortisol response at 60 minutes post-ACTH-ST could indicate adrenal insufficiency in this context.
- Further research with larger cohorts is needed to validate these findings.
Related Concept Videos
01:19Cushing Syndrome II: Pathophysiology
Cortisol production is normally governed by the hypothalamic–pituitary–adrenal (HPA) axis, which maintains hormonal balance through tightly regulated feedback mechanisms. Disruption of this regulatory system is central to the development of Cushing syndrome, whether the excess cortisol originates from external medications or internal pathology. Persistent cortisol elevation alters metabolism, immune function, and endocrine signaling, producing the characteristic clinical features of the...
01:26Cushing Syndrome I: Introduction
Cushing syndrome refers to the collection of clinical manifestations that arise when tissues are exposed to excessive amounts of cortisol or cortisol-like medications over an extended period. Cortisol, a glucocorticoid produced by the adrenal cortex, regulates metabolism, immune responses, and the body’s adaptation to stress. When its concentration remains chronically elevated, these physiological pathways become dysregulated, resulting in the characteristic features of the syndrome.Exogenous...
01:37Hypothalamic-Pituitary Axis
The response to stress—be it physical or psychological, acute or chronic—involves activation of the Hypothalamic-Pituitary-Adrenal (HPA) axis. The HPA axis is part of the neuroendocrine system because it involves both neuronal and hormonal communication. Its function is to regulate homeostatic systems—metabolic, cardiovascular, and immune—providing the necessary means to respond to a stressor.
01:27Adrenal Gland Disorders
Adrenal gland disorders manifest when the production of adrenal hormones deviates from the norm, resulting in either excessive or insufficient concentrations.
Adrenal insufficiency, characterized by insufficient cortisol and aldosterone production, leads to conditions like Addison's disease. This disorder, affecting the adrenal cortex, exhibits symptoms such as skin bronzing, dehydration, low blood pressure, fatigue, and weight loss. Congenital adrenal hyperplasia, a genetic ailment causing...
Adrenal insufficiency, characterized by insufficient cortisol and aldosterone production, leads to conditions like Addison's disease. This disorder, affecting the adrenal cortex, exhibits symptoms such as skin bronzing, dehydration, low blood pressure, fatigue, and weight loss. Congenital adrenal hyperplasia, a genetic ailment causing...
01:31Hormones of the Adrenal Glands
Adrenal hormones play a pivotal role in maintaining the body's electrolyte balance and orchestrating responses to stress, showcasing the intricate functions of the adrenal cortex and medulla.
The adrenal cortex, a powerhouse of hormone synthesis, generates over two dozen corticosteroid hormones. The zona glomerulosa produces mineralocorticoids, exemplified by aldosterone, influencing the electrolyte composition of body fluids. The synthesis of glucocorticoids such as cortisol and corticosterone...
The adrenal cortex, a powerhouse of hormone synthesis, generates over two dozen corticosteroid hormones. The zona glomerulosa produces mineralocorticoids, exemplified by aldosterone, influencing the electrolyte composition of body fluids. The synthesis of glucocorticoids such as cortisol and corticosterone...
01:21Drugs for Treatment of Crohn's Disease in IBD Using Glucocorticoids
Glucocorticoids, a class of anti-inflammatory drugs, are pivotal in treating moderate to severe Crohn's disease by inducing remission. They exhibit their anti-inflammatory action by inhibiting the production of inflammatory cytokines such as tumor necrosis factor (TNF)-α, interleukin (IL)-1, and chemokines like IL-8. In addition, they reduce the expression of inflammatory cell adhesion molecules and inhibit gene transcription of nitric oxide synthase, phospholipase A2, cyclooxygenase-2 (COX-2),...