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Comparison of low-dose and high-dose cosyntropin stimulation testing in children

Ayse Pinar Cemeroglu1, Lora Kleis, Daniel C Postellon

  • 1Helen DeVos Children's Hospital, Spectrum Health Medical Group, Michigan State University, Pediatric Endocrinology and Diabetes Clinic, Grand Rapids, Michigan, USA. ayse.cemeroglu@devoschildrens.org

Pediatrics International : Official Journal of the Japan Pediatric Society
|July 15, 2010
PubMed

Insights

Low-dose (LD) cosyntropin testing for adrenal insufficiency in children requires cautious interpretation. A lower cut-off of 14 µg/dL for LD testing can help avoid false positives while still identifying impaired hypothalamic-pituitary-adrenal axis function.

Area of Science:

  • Pediatric Endocrinology
  • Endocrinology
  • Adrenal Insufficiency Testing

Background:

  • Lack of consensus exists regarding low-dose (LD) versus high-dose (HD) cosyntropin testing for secondary/tertiary adrenal insufficiency in children.
  • This study evaluates the efficacy of LD and HD cosyntropin stimulation tests in pediatric patients.

Purpose of the Study:

  • To compare LD and HD cosyntropin stimulation testing in children for hypothalamic-pituitary-adrenal axis (HPAA) evaluation.
  • To propose a new peak cortisol cut-off value for LD cosyntropin testing to minimize false-positive results.

Main Methods:

  • Retrospective analysis of 36 children undergoing LD (1 µg) and HD (249 µg) cosyntropin testing during growth hormone (GH) stimulation tests.
  • Patients were divided into two groups: Group A (intact HPAA) and Group B (impaired HPAA or steroid use).

Main Results:

  • In children with intact HPAA (Group A), mean peak cortisol was 18.5 ± 2.4 µg/dL for LD and 24.8 ± 3.1 µg/dL for HD testing.
  • In children with impaired HPAA (Group B), mean peak cortisol was 15.7 ± 6.1 µg/dL for LD and 21.7 ± 7.9 µg/dL for HD testing.
  • Using a standard 18 µg/dL cut-off, 37% of patients with intact HPAA showed a false-positive result with LD testing; a 14 µg/dL cut-off eliminated these false positives.

Conclusions:

  • LD cosyntropin stimulation testing requires careful interpretation to prevent unnecessary long-term treatment.
  • A lower cut-off value (≥14 µg/dL) for LD cosyntropin testing appears effective in avoiding false positives while still detecting most cases of impaired HPAA in children.
Abstract

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