Value of an ACTH test in assessing hypothalamic-pituitary-adrenocortical function in glucocorticoid-treated patients

Forty-eight patients receiving glucocorticoid treatment were tested with ACTH stimulation using alpha(1, 24) ACTH (tetracosactrin). All patients subsequently underwent non-acute major surgery without any glucocorticoid administration, and their clinical course and plasma corticosteroids were followed closely. No case of adrenocortical insufficiency was observed. A highly significant correlation was found between the pre-operative adrenocortical response to ACTH and the hypothalmic-pituitary-adrenocortical (H.P.A.) response to surgery. A normal response to ACTH stimulation was never followed by a greatly impaired H.P.A. response to surgery. It seems that a simple ACTH stimulation test is reliable in predicting the integrated H.P.A. response to major stress in glucocorticoid-treated patients.