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Abstract: FR-PO689

Comparison of Low and Standard Dose Adrenocorticotropic Hormone (ACTH) Stimulation Test in the Diagnosis of Adrenal Insufficiency in Peritoneal Dialysis Patients

Session Information

Category: Dialysis

  • 703 Dialysis: Peritoneal Dialysis

Authors

  • Oh, Yun Jung, Cheju Halla General Hospital, Jeju, Korea (the Republic of)
  • Lee, Su mi, Dong-A University hospital, BUSAN, Korea (the Republic of)
  • Ryu, Jiwon, Cheju Halla General Hospital, Jeju, Korea (the Republic of)
  • Lee, Chungsik, Cheju Halla General Hospital, Jeju, Korea (the Republic of)
Background

Adrenocorticotropic hormone (ACTH) stimulation test is the current standard for diagnosing adrenal insufficiency (AI). The low dose (1 μg) ACTH stimulation test (LDT) has been introduced to detect incomplete impairment of adrenal function with partial corticotropin deficiency, which might be masked by the conventional supraphysiological dose (250 μg) of ACTH employed in the standard dose ACTH stimulation test (SDT). Indeed, several studies have shown an increased sensitivity of LDT over SDT in chronic ill patients with secondary AI. This study aims to investigate the diagnostic value of low and standard dose ACTH stimulation tests for identifying AI in patients on peritoneal dialysis (PD).

Methods

A total of 60 prevalent PD patients were enrolled and underwent LDT and SDT using doses of 1 μg and 250 μg synthetic ACTH, respectively. The two tests were performed in random sequence with minimum one week interval and a cut-off level of peak serum cortisol for AI was <18 μg/dL in both tests. Surveys of AI-associated symptoms and laboratory test were performed.

Results

Overall, 22 (36.7%) patients in the LDT and 8 (13.3%) patients in the SDT showed an insufficient increase of cortisol to ACTH stimulation and were categorized as having AI. In the LDT, no remarkable difference in presence of symptoms associated with AI was observed between the AI patients and non-AI patients. Laboratory findings were not different between the two groups, either. However, the patients who were diagnosed with AI by the SDT complained fatigue (62.5% vs. 15.4%, P=0.009) and constipation (50.0% vs. 13.5%, P=0.031) more frequently compared with the patients without AI. The adequacy of dialysis (Kt/V) was significantly lower in patients diagnosed with AI by the SDT than non-AI patients (1.64±0.21 vs. 1.99±0.37, P=0.019).

Conclusion

Adrenal response to ACTH was diminished in low dose compared with standard dose and the use of LDT diagnosed more adrenal abnormalities than SDT in PD patients. However, the clinical significance of identifying AI patients using the LDT was not observed in those patients.