cosyntropin and ACTH-Syndrome--Ectopic

Topics: ACTH Syndrome, Ectopic; Addison Disease; Adrenocorticotropic Hormone; Corticotropin-Releasing Hormone; Cosyntropin; Cushing Syndrome; Delayed-Action Preparations; Dexamethasone; Evaluation Studies as Topic; Humans; Hypopituitarism; Immunoradiometric Assay; Nelson Syndrome; Reagent Kits, Diagnostic; Reproducibility of Results; Sensitivity and Specificity

We evaluated a new, commercially available two-site immunoradiometric assay (IRMA) for corticotropin (ACTH) in human plasma. The precision and detection limit were an improvement over radioimmunoassay (RIA). Addition of ACTH 1-24 or ACTH 18-39 to plasma containing ACTH 1-39 resulted in a decrease in measured ACTH. Results by both IRMA and RIA are reported and compared for normal subjects, patients with Cushing's disease, and patients with ectopic ACTH. Effects of administering dexamethasone, metyrapone, ACTH 1-24, and corticoliberin were evaluated. The present assay is more sensitive, specific, and reproducible than RIA. The presence of fragments of ACTH or "big" ACTH that are reactive in RIA may lead to artifactually low ACTH concentrations by IRMA. Therefore, RIA may still be necessary for differential diagnosis of ectopic ACTH syndromes. However, the IRMA is an improvement for evaluating pituitary--adrenal function in patients with low concentrations of ACTH in plasma.

Topics: ACTH Syndrome, Ectopic; Adrenocorticotropic Hormone; Adult; Corticotropin-Releasing Hormone; Cosyntropin; Cushing Syndrome; Dexamethasone; Humans; Hydrocortisone; Immunoassay; Male; Metyrapone; Quality Control; Radioimmunoassay