New diagnostic approaches to subclinical adrenal insufficiency
Authors:
K. Šimůnková 1,2; K. Vondra 1
Authors‘ workplace:
Endokrinologický ústav, Praha
Ředitel: doc. MUDr. Vojtěch Hainer, CSc.
1; III. interní klinika 1. LF UK a VFN, Praha
Přednosta: prof. MUDr. Štěpán Svačina, DrSc. MBA
2
Published in:
Prakt. Lék. 2009; 89(12): 698-702
Category:
Diagnostis
Overview
The diagnosis of subclinical forms of hypocorticalism is an ongoing problem. New diagnostic approaches to adrenal insufficiency are still being sought, aimed at increasing and improving the specificity and sensitivity of results. Correct interpretation of the results is a pre-condition to early and correct treatment. Dynamic tests play a major role in the diagnosis of various degrees of hypocorticalism. The low dose ACTH test is described in detail, and its benefits and disadvantages are reviewed in comparison to standard high dose ACTH test. Evaluation of free fraction of cortisol would be beneficial, but is technically challenging. Therefore the total serum cortisol is assessed, but its concentration is affected by binding proteins of cortisol, especially by the concentration of transcortin. Estrogens in combined oral contraception are a big problem in daily practice since estrogens increase the concentration of transcortin and consequently the levels of cortisol are artificially increased. At the end of the article, the authors discuss new diagnostic approaches - mainly the evaluation of salivary cortisol.
Key words:
adrenal insufficiency, Short Synacthen test, low-dose ACTH test, transcortin, salivary cortisol.
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