An attempt to create a treatment algorithm of central adrenal insufficiency using CRH test, DHEA-S and clinical evaluation

• Published in: The Journal of Medical Investigation Vol. 69; no. 3.4; pp. 287 - 293
• Main Authors: Mitsui, Yukari, Iizuka, Yuto, Tanaka, Tomoaki, Hara, Tomoyo, Masuda, Shiho, Ohnishi, Yukiyo, Kanai, Mai, Kurahashi, Kiyoe, Yoshida, Sumiko, Kondo, Takeshi, Kanezaki, Toshiko, Shintani, Yasumi, Yamagami, Hiroki, Yamaguchi, Yuki, Fujinaka, Yuichi, Morimoto, Kana, Shirakami, Atsuhisa, Aihara, Ken-ichi, Fukumoto, Seiji, Abe, Masahiro, Endo, Itsuro
• Format: Journal Article
• Language: English
• Published: The University of Tokushima Faculty of Medicine 2022
• Subjects: central adrenal insufficiency; corticotropin-releasing hormone (CRH) test; dehydroepiandrosterone-sulfate (DHEA-S); retrospective cohort study; treatment algorithm
• ISSN: 1343-1420; 1349-6867
• DOI: 10.2152/jmi.69.287

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