Plasma Immunoassayable ACTH Levels during and after Hydrocortisone Infusion in Patients with Cushing's Disease

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Abstract
The plasma ACTH responses to hydrocortisone infusion were compared in patients with Cushing''s disease and primary adrenocortical insufficiency. In 4 patients with primary adrenocortical insufficiency, plasma ACTH levels were suppressed exponentially after administration of a relatively large dose of hydrocortisone (1.0 mg/kg per 1.5 h-3.0 mg/kg per 2 h). In patients with post-adrenalectomized Cushing''s disease (4, bilateral; 1, unilateral), plasma ACTH suppression was delayed. Plasma ACTH levels, expressed as a percentage of the basal concentrations, were significantly less suppressed in patients with Cushing''s disease than in patients with primary adrenocortical insufficiency 90 (P < 0.05) and 120 (P < 0.05) min after the beginning of infusion. When 0.5 mg/kg hydrocortisone was infused over a period of 1.5 h, suppression was delayed in Cushing''s disease, and plasma ACTH levels were less suppressed in 4 patients with Cushing''s disease than in 4 patients with primary adrenocortical insufficiency at 30 (P > 0.05), 45 (P > 0.05), 60 (P < 0.01) and 90 (P < 0.05) min.

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