Low-Dose ACTH Stimulation Test in Obesity: A Randomized Dose Assessment

Area of Science:

• Endocrinology
• Metabolic Disorders

Background:

• The short cosyntropin test is standard for adrenal insufficiency diagnosis.
• Obesity is increasingly prevalent, affecting over 50% of autoimmune adrenal insufficiency cases.
• Fixed-dose cosyntropin may be inappropriate for individuals with obesity.

Purpose of the Study:

• Compare cortisol response to weight-adapted vs. fixed low-dose (1 µg) and standard (10 µg) cosyntropin stimulation.
• Evaluate the efficacy of different cosyntropin doses in individuals with obesity.

Main Methods:

• Twenty individuals with obesity and 20 healthy controls participated.
• A randomized sequence of short cosyntropin tests using 0.2 µg/kg, 1 µg, and 10 µg doses was administered.
• Blinded assessment and data analysis were performed.

Main Results:

• The 1 µg fixed dose showed reduced cortisol response at 30 minutes in the obesity group (p=0.04).
• A dose-dependent trend of lower cortisol peak at 60 minutes was observed across all doses.
• A weight-adapted dose of 0.2 µg/kg yielded responses comparable to controls.

Conclusions:

• The 1 µg cosyntropin test is inadequate for assessing adrenal response in obesity.
• Weight-adapted dosing (0.2 µg/kg) is recommended for accurate adrenal function evaluation in individuals with obesity.