The daily rhythm of secretion of adrenocorticotropic hormone in assessing the adequacy of replacement therapy for primary chronic adrenal insufficiency

Plasma level о] АС 1Н was radioimmunoassayed every 4 hours for 24 h in three groups of patients in order to evaluate the possibility of using circadian rhythm of ACTH secretion for assessment of the efficacy of substitute glucocorticoid therapy for primary chronic adrenal insufficiency (CAI-1, Addison’s disease). In group 1 (n = 14) patients with CAI-1 were treated with prednisolone (5 mg at 9.00 and 2.5 mg at 14.00), in group 2 dexamethasone (0.5 mg at 23.00) and prednisolone (2.5 mg at 14.00). In addition, all patients with CAI-1 were administered 9a-fluorocortisol in a daily dose of0.005-0.01 mg. Control group consisted of 14 healthy volunteers.

The level of A CTH varied within a wide range in both variants of substitute therapy in comparison with the norm. The areas under the curve reflecting ACTH concentrations within 24h differed negligibly in groups 1 and 2 and in group 2 and control. The area under ACTH curve in group 1 was significantly larger than in the control. The mean concentrations of ACTH in group I at 7.00 and 11.00 were significantly higher than in the two other groups. In general, circadian rhythms of ACTH secretion were closer to the norm in the patients treated with dexamethasone. According to our clinical experience, dexamethasone had to be discontinued because of the overdosage syndrome (body weight excess, high appetite and insomnia) in at least 2/3 of patients initially prescribed this agent, and therefore we conclude that the clinical picture and data on the 24-h rhythm of A CTH secretion disagree. Evaluating the results of substitute therapy for CAI-1, one should remember that normal rhythm of ACTH secretion during 24 h does not rule out overdosage of glucocorticoids, and therefore the results of laboratory tests should be interpreted with due consideration for the clinical picture.

adrenocorticotropic hormone, chronic adrenal insufficiency, replacement therapy

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