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

Yukari Mitsui, Yuto Iizuka, Tomoaki Tanaka, Tomoyo Hara, Shiho Masuda, Yukiyo Ohnishi, Mai Kanai, Kiyoe Kurahashi, Sumiko Yoshida, Takeshi Kondo, Toshiko Kanezaki, Yasumi Shintani (+9 others)
2022 Journal of Medical Investigation  

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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
more » ... red 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.
doi:10.2152/jmi.69.287 pmid:36244782 fatcat:mia2j5werzd6faznhdn6f42xwy
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Yukari Mitsui, Yuto Iizuka, Tomoaki Tanaka, Tomoyo Hara, Shiho Masuda, Yukiyo Ohnishi, Mai Kanai, Kiyoe Kurahashi, Sumiko Yoshida, Takeshi Kondo, Toshiko Kanezaki, Yasumi Shintani, Hiroki Yamagami, Yuki Yamaguchi, Yuichi Fujinaka, Kana Morimoto, Atsuhisa Shirakami, Ken-ichi Aihara, Seiji Fukumoto, Masahiro Abe, Itsuro Endo. "An attempt to create a treatment algorithm of central adrenal insufficiency using CRH test, DHEA-S and clinical evaluation." Journal of Medical Investigation 69.3.4 (2022) 287-293