Plasma Immunoassayable ACTH Levels during and after Hydrocortisone Infusion in Patients with Cushings Disease

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The plasma ACTH responses to hydrocortisone infusion were compared in patients with Cushings disease and primary adrenocortical insufficiency. In 4 patients with primary adrenocortical insufficiency, plasma ACTH levels were suppressed exponentially after administration of a relatively large dose of hydrocortisone (1.0 mg/kg/1.5 hr-3.0mg/kg/2 hr). In patients with post-adrenalectomized Cushings disease (4, bilateral; 1, unilateral), plasma ACTH suppression was delayed. Plasma ACTH levels, expressed as a percentage of the basal concentrations, were significantly less suppressed in patients with Cushings disease than in patients with primary adrenocortical insufficiency 90 (p<0.05) and 120 (p<0.05) min after the beginning of infusion. When 0.5mg/kg hydrocortisone was infused over a period of 1.5 hr, suppression was also delayed in Cushings disease, and plasma ACTH levels were less suppressed in 4 patients with Cushings disease than in 4 patients with primary adrenocortical insufficiency at 30 (p>0.05), 45 (p>0.05), 60 (p<0.01) and 90 (p<0.05) min.
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