Intramuscular short-term ACTH test for the determination of adrenal function in children: safe, effective and reliable

Standart short ACTH stimulation test (SST) has been used for detecting adrenal gland fuction for several years by intravenous (iv). However iv form has not been accessed easily in some countries like ours. The aim of this study was to evaluate the effectiveness of the intramuscular (im) SST.Patients were underwent SST with suspected adrenal insufficiency and hyperandrogenism. The SSTs were done with 250 mcg ACTH (Synacthen Depot ampul, concentration 1mg/ml). The cases were divided into two groups: suspected adrenal insufficiency (Group 1 n:87); and hyperandrogenism group (Group 2 n:124). Peak cortisol <18 mcg/dl, was defined as adrenal insufficiency, suspected adrenal insufficiency as a peak cortisol of 18-22 mcg/dl and normal result was defined as a peak cortisol ≥22 mcg/dl.The mean age of the patients was 11.7±5.2 years. In 164 patients (78%) all of the peak cortisol tests were found normal ≥22 mcg/dl. This rates were 64% and 88% in Group 1 and 2 respectively. Only 8.5% (n=18) of all cases had had an inadequate peak cortisol response of <18 mcg/dl. On follow up, 15 patients needed cortisol therapy whose peak cortisol was <18 mcg/dl. Of all cases 3.3% (n=8) had 17-OHP ≥10 ng/dl. NCCAH clinic findings and/or mutation were found in six of these cases. No local and systemic side effects or allergic reactions were observed in any patient.Intramuscular form of ACTH test is a safe, effective and reliable test in children with suspected AI. Not seems any local and systemic side effects which supported the reliability of the im ACTH test.