cosyntropin and Kidney-Failure--Chronic

In order to know the prevalence rate of adrenal insufficiency among patients with renal failure due to amyloidosis; we have performed a stimulation test with synthetic corticotropin hormone (Nuvacthen test) in nine patients diagnosed of renal amyloidosis and in five controls. We also measured ACTH and plasma cortisol levels. In two out of nine patients (22%) a low ACTH, low plasmatic cortisol and an abnormal response to Nuvacthen test were detected being diagnosed of primary adrenal insufficiency. We conclude that adrenal insufficiency is not an infrequent finding in systemic amyloidosis and may be due to secondary amyloidotic infiltration of adrenal or pituitary glands. Though Nuvacthen test is a useful test to diagnose subclinical adrenal insufficiency, in our series patients with an abnormal response also had low levels of basal cortisol and ACTH and no one patient with normal basal levels had an abnormal response to the stimulation test.

Topics: Adrenal Insufficiency; Adrenocorticotropic Hormone; Adult; Aged; Amyloidosis; Cosyntropin; Female; Humans; Hydrocortisone; Kidney Failure, Chronic; Male; Middle Aged; Stimulation, Chemical; Time Factors

Amyloidosis is a multi-system disease. Renal involvement often leads to end-stage renal failure, which carries a poor prognosis. This paper reports the adrenal status of 22 patients with renal amyloid who were considered for or who had been commenced on renal replacement therapy. Twelve patients were considered or found to have AA amyloid and the remaining 10 had AL amyloid. Of 16 patients tested, seven demonstrated an abnormal response to a synacthen test. Four patients died at Addisonian crisis and hypo-adrenalism probably contributed to the deaths of a further two patients. Amyloid deposition was found in the adrenal glands in seven patients who died of systemic amyloidosis and renal failure. It is recommended that all patients with renal amyloid should have an assessment of adrenal function performed and if abnormal replacement steroid therapy should be commenced.

Topics: Adrenal Gland Diseases; Adrenal Glands; Adult; Aged; Amyloidosis; Cosyntropin; Female; Humans; Kidney; Kidney Diseases; Kidney Failure, Chronic; Kidney Transplantation; Liver; Male; Middle Aged; Myocardium

1) A stable group of hemodialysis patients in our study do not have a normal response to the cosyntropin test; 2) although one would expect chronic renal failure patients to accommodate to hemodialysis, our study demonstrates that hemodialysis may still serve as a useful stress test; 3) the reduced response to the metyrapone suppression test in our stable group of hemodialysis patients suggests impairment of the feedback mechanism of the pituitary-adrenal axis.

Topics: Adrenal Cortex; Adrenocorticotropic Hormone; Adult; Cosyntropin; Female; Humans; Hydrocortisone; Kidney Failure, Chronic; Male; Metyrapone; Middle Aged; Pituitary Gland; Renal Dialysis