Relationship between cortisol increment and basal : assessing corticotrop insufficiency

What is it about?

The insulin tolerance test (ITT) is accepted as the gold-standard test in the evaluation of adrenal and GH axis in patients with pituitary disorders. Diagnostic criteria that requires a minimum increment in serum cortisol is considered invalid although individuals who have a lower basal serum cortisol concentration because of recent ACTH deficiency may be maximally stimulated by ITT and thus able to further increase cortisol secretion without reaching the cut-off. Analyzing the relationship between cortisol Increment and basal cortisol could lead to precious information, and perform a prediction of adrenal insufficiency (AI). We therefore decided to investigate the relationship between the peak and basal cortisol values after the ITT.

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Why is it important?

Our study showed a marked interdependence of the basal cortisol concentration, peak cortisol concentration, and increases in serum cortisol concentration. Our finding indicates that, considering the induced cortisol increment peak cut-off of 87 ng/ml, we can identify, with a statistical concordance, 84.04% of adrenal insufficient under ITT.

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