An attempt to create a treatment algorithm of central adrenal insufficiency using CRH test, DHEA-S and clinical evaluation
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- Mitsui Yukari
- Department of Hematology, Endocrinology & Metabolism, Tokushima University Graduate School of Biomedical Sciences, Tokushima, Japan
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- Iizuka Yuto
- Department of Hematology, Endocrinology & Metabolism, Tokushima University Graduate School of Biomedical Sciences, Tokushima, Japan
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- Tanaka Tomoaki
- Department of Hematology, Endocrinology & Metabolism, Tokushima University Graduate School of Biomedical Sciences, Tokushima, Japan
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- Hara Tomoyo
- Department of Hematology, Endocrinology & Metabolism, Tokushima University Graduate School of Biomedical Sciences, Tokushima, Japan
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- Masuda Shiho
- Department of Hematology, Endocrinology & Metabolism, Tokushima University Graduate School of Biomedical Sciences, Tokushima, Japan
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- Ohnishi Yukiyo
- Department of Hematology, Endocrinology & Metabolism, Tokushima University Graduate School of Biomedical Sciences, Tokushima, Japan
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- Kanai Mai
- Department of Bioregulatory Sciences, Tokushima University Graduate School of Biomedical Sciences, Tokushima, Japan
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- Kurahashi Kiyoe
- Department of Hematology, Endocrinology & Metabolism, Tokushima University Graduate School of Biomedical Sciences, Tokushima, Japan
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- Yoshida Sumiko
- Department of Hematology, Endocrinology & Metabolism, Tokushima University Graduate School of Biomedical Sciences, Tokushima, Japan
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- Kondo Takeshi
- Department of Diabetes and Endocrinology, Tokushima Red Cross Hospital, Komatsushima, Japan
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- Kanezaki Toshiko
- Department of Diabetes and Endocrinology, Tokushima Red Cross Hospital, Komatsushima, Japan
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- Shintani Yasumi
- Department of Diabetes and Endocrinology, Tokushima Red Cross Hospital, Komatsushima, Japan
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- Yamagami Hiroki
- Department of Hematology, Endocrinology & Metabolism, Tokushima University Graduate School of Biomedical Sciences, Tokushima, Japan
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- Yamaguchi Yuki
- Department of Internal Medicine, Tokushima Prefecture Naruto Hospital, Naruto Japan
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- Fujinaka Yuichi
- Department of Internal Medicine, Tokushima Prefecture Naruto Hospital, Naruto Japan
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- Morimoto Kana
- Department of Diabetology and Metabolic Medicine, Tokushima Prefectural Central Hospital, Tokushima, Japan
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- Shirakami Atsuhisa
- Department of Diabetology and Metabolic Medicine, Tokushima Prefectural Central Hospital, Tokushima, Japan
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- Aihara Ken-ichi
- Department of Community Medicine and Medical Science, Tokushima University Graduate School of Biomedical Sciences, Tokushima, Japan
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- Fukumoto Seiji
- Fujii Memorial Institute of Medical Sciences, Tokushima University, Tokushima, Japan
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- Abe Masahiro
- Department of Hematology, Endocrinology & Metabolism, Tokushima University Graduate School of Biomedical Sciences, Tokushima, Japan
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- Endo Itsuro
- Department of Bioregulatory Sciences, Tokushima University Graduate School of Biomedical Sciences, Tokushima, Japan
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Description
<p>Objective : To examine diagnostic performance of corticotropin-releasing hormone (CRH) test combined with baseline dehydroepiandrosterone sulfate (DHEA-S) in patients with a suspect of central adrenal insufficiency. Methods : Patients (n=215) requiring daily or intermittent hydrocortisone replacement, or no replacement were retrospectively checked with their peak cortisol after CRH test and baseline DHEA-S. Results : None of 106 patients with the peak cortisol ≥ 17.5 µg / dL after CRH test required replacement, and all 64 patients with the peak cortisol < 10.0 µg / dL required daily replacement. Among 8 patients with 10.0 µg / dL ≤ the peak cortisol < 17.5 µg / dL and baseline DHEA-S below the reference range, 6 patients required daily replacement and 1 patient was under intermittent replacement. Among 37 patients with 10.0 µg / dL ≤ the peak cortisol < 17.5 µg / dL and baseline DHEA-S within the reference range, 10 and 6 patients were under intermittent and daily replacement, respectively. Conclusions : No patients with the peak cortisol ≥ 17.5 µg / dL required hydrocortisone replacement, and all patients with the peak cortisol below 10.0 µg / dL required daily replacement. Careful clinical evaluation was required to determine requirement for replacement in patients with 10.0 µg / dL ≤ the peak cortisol < 17.5 µg / dL even in combination with baseline DHEA-S. J. Med. Invest. 69 : 287-293, August, 2022</p>
Journal
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- The Journal of Medical Investigation
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The Journal of Medical Investigation 69 (3.4), 287-293, 2022
The University of Tokushima Faculty of Medicine