Abstract
The ACTH test has been used to confirm the diagnosis of adrenal insufficiency and the classic and the non-classic adrenal hyperplasia due to the 3-HSD, 21 OH e 110H deficiencies. This article reviews the historical aspects of the use of ACTH in the diagnosis of hirsutism and points out its mains indications. In spite of new biological molecular advances in the diagnosis of adrenal enzymatic deficiencies, the use of the ACTH test can help the physician to predict both genothipus and fenothipus in populations with hyperandrogenic manifestations due to non-classical or late-onset congenital adrenal hyperplasia.
Highlights
Historical aspectsS ince the introduction of the test involving infusion of pituitary adrenocorticotropin hormone (ACTH) in 1948, I clinicians and gynecologists in general have been using the method to evaluate adrenal function in patients suspected of having adrenal insufficiency or congenital adrenal hyperplasia.As far as the gynecological aspects are concerned, clinicians must be alert to the interpretation of the test; recent publications point out that patients with congenital adrenal hyperplasia in its late-onset or non-classical form lnay present a clinicaI picture consisting of irregular menses, hirsutism and other hyperandrogenic lnanifestations.ACTH is a physiological agent that stimulates the biosynthesis of the adrenal cortex layers and is directlyAddress for correspondence: Marco Fábio Prata Lima
AZZIZ & ZACUR consider women to be carriers when their 17-0H-progesterone leveIs exceed 1200 ng/dl after intravenous ACTH infusion.x In contrast, DEWAILLY et aI. suggested that patients with 170Hprogesterone leveIs exceeding SOO ng/dl which are reduced by dexamethasone should not be submitted to the ACTH stimulation test as they would be considered to have nonclassical21-0H deficiency
To evaluate 3-HSD activity, the diagnostic criteria most frequently employed were those proposed by PANG et aI., i.e.: 1. post-stimulus 17-0H-pregnenolone leveIs two standard deviations above the leveIs detected in normal women (S 170H-P>1639 ng/dl OI'49.2 nmol/I); 2. poststimulus DHEA leveIs two standard deviations above the leveIs observed in normal women (DHEA> 1818 ng/dl 01' 63.1 nmoll1); 3. 170H-pregnenolone/170H-progesterone ratio two standard deviations above the values detected in normal women C170H-progesterone>6.4); and 4. 170Hpregnenolone/cortisol ratio two standard deviations above normal values (170H-pregnenolone/cortisol>S2).'o
Summary
The ACTH test has been used to confirm the diagnosis of adrenal insufficiency and the classic and the non-classic adrenal hyperplasia due to the 3-HSD, 21 OH e 11OH deficiencies. This article reviews the historical aspects of the use of ACTH in the diagnosis of hirsutism and points out its mains indications. In spite of new biological molecular advances in the diagnosis of adrenal enzymatic deficiencies, the use of the ACTH test can help the physician to predict both genothipus and fenothipus in populations with hyperandrogenic manifestations due to non-c1assical or late-onset congenital adrenal hyperplasia
Sign-in/Register to view highlights & summary Sign-in/Register to access full text options 
Talk to us
Join us for a 30 min session where you can share your feedback and ask us any queries you have
Schedule a callMore From: Sao Paulo medical journal = Revista paulista de medicina
Disclaimer: All third-party content on this website/platform is and will remain the property of their respective owners and is provided on "as is" basis without any warranties, express or implied. Use of third-party content does not indicate any affiliation, sponsorship with or endorsement by them. Any references to third-party content is to identify the corresponding services and shall be considered fair use under The CopyrightLaw.
