THE HORMONAL AND RADIOLOGICAL EVALUATION OF ADRENAL GLANDS, AND THE DETERMINATION OF THE USEFULNESS OF LOW DOSE ACTH TEST IN PATIENTS WITH RENAL AMYLOIDOSIS

Figures & data

Table 1. Plasma Cortisol, 11-DOC, and 17-OHP Responses to 1 μg and250 μg Synacthen Stimulation Tests

	1 μgSynacthen Stimulation Test				250μg Synacthen Stimulation Test
	Patients		Controls		Patients		Controls
	n	X±SD	n	X±SD	n	X±SD	n	X±SD
Plasma cortisol (μg/dL)
Basal Values	21	16.62±5.94	16	17.27±4.16	21	15.51±6.47	16	16.59±7.64
30 minute	21	26.92±10.57	16	34.10±11.42	21	24.70±8.768^§3	16	30.62±5.73
60 minute	21	26.09±8.58	16	29.03±8.52	21	28.27±9.388^§3	16	35.87±10.28
90minute	21	23.14±7.752^*2	16	23.98±7.945^*5	21	30.09±10.828^§3	16	37.40±7.87
120 minute	21	20.47±8.131^*1	16	16.82±4.893^*3	21	31.40±13.06	16	39.31±8.01
Plasma 11-DOC (ng/mL)
Basal Values	20	1.04±0.90	12	2.48±0.72	21	0.97±0.916^§1	11	2.46±1.20
30minute	20	1.55±1.401^*1, 6^§1	12	3.68±0.91	21	1.86±1.487^§2	11	3.60±1.14
60 minute	20	1.40±1.252^*2, 6^§1	12	3.09±0.69	21	2.15±1.937^§3	11	3.86±1.37
90 minute	20	1.22±1.113^*3, 6^§1	12	2.80±0.50	21	2.31±1.898^§3	11	4.15±1.74
120 minute	20	1.15±1.073^*3	12	2.68±0.694^*4	21	2.37±1.898^§3	11	4.14±1.61
Plasma 17-OHP(ng/mL)
BasalValues	18	1.18±1.17	12	1.29±0.88	21	0.78±0.65	11	1.02±0.57
30minute	18	1.84±1.49	12	2.36±1.26	21	2.02±1.22	11	2.62±1.30
60minute	18	1.55±1.36	12	1.46±0.70	21	2.13±1.24	11	3.01±1.38
90minute	18	1.32±1.111^*1	12	1.30±0.614^*4	21	1.30±0.61	11	2.47±1.20
120 minute	18	1.15±1.191^*1	12	1.19±0.721^*1	21	1.19±0.72	11	3.00±1.54s

^*1p< 0.01 as compared with standard stimulation test.

^*2p= 0.01 as compared with standard stimulation test.

^*3p= 0.000 as compared with standard stimulation test.

^*4p< 0.05 as compared with standard stimulation test.

^*5p= 0.001 as compared with standard stimulation test.

^§1p= 0.000 as compared with control values.

^§2p< 0.01 as compared with control values.

^§3p< 0.05 as compared with control values.

Table 2. Cortisol Response to Synacthen Stimulation Test in Patientswith Renal Amy-loidosis

	Plasma Cortisol Levels(μg/dL)
	1 μg ACTH		250μg ACTH
Case No	BasalLevels	Peak Levels	BasalLevels	Peak Levels
1	17.09	48.22	16.68	52.39
2	26.64	27.61	13.37	21.53
3	17.13	48.59	18.25	36.40
4	7.50	33.95	7.30	30.19
5	22.15	44.34	18.43	23.62
69^*	15.29	15.88	15.61	19.13
7	25.96	38.72	31.52	47.29
8	16.56	30.63	17.62	32.22
9	17.64	28.28	24.66	55.92
10	13.13	28.30	7.58	38.13
11	17.05	30.80	6.69	28.12
12	14.03	24.17	11.40	29.18
13	18.75	21.14	14.34	39.00
14	13.11	25.73	19.96	49.94
15	25.08	38.09	26.13	57.01
16	4.04	31.45	16.31	31.84
17	10.24	24.47	16.08	27.29
189^*	8.61	16.68	6.82	20.14
199^*	17.76	19.79	12.33	26.47
20	24.48	28.28	13.91	21.61
219^*	14.54	16.95	10.82	26.31
Mean	16.62 ± 5.94	29.48 ± 9.88	15.51± 6.47	33.99 ± 12.04

^*Insufficient cortisol responseto Synacthen test.

Table 3. Cortisol Response to Synacthen Stimulation Test in NormalIndividuals

	Plasma Cortisol Levels(μg/dL)
	1 μg ACTH		250μg ACTH
Case No	BasalLevels	Peak Levels	BasalLevels	Peak Levels
1	12.93	22.01	14.42	35.19
2	17.54	27.73	11.36	29.98
3	20.60	30.93	11.80	32.34
4	16.46	29.34	9.90	47.44
5	12.47	29.26	17.78	33.20
6	15.95	52.01	24.29	34.89
7	15.69	36.28	9.96	36.92
8	17.85	51.35	9.24	35.58
9	15.71	61.32	20.62	44.35
10	24.15	44.82	8.10	25.62
11	12.69	31.30	10.37	44.58
12	14.96	25.54	18.08	38.64
13	25.08	28.01	32.70	48.91
14	24.53	24.83	28.66	49.41
15	14.77	30.12	21.59	62.75
16	14.99	31.80
Mean	17.27 ± 4.16	35.12± 11.59	16.59 ± 7.64	39.99 ± 9.53

Table 4. Plasma Cortisol Responses to 1 μg and 250 μg SynacthenStimulation Tests in Patients with CRF and Proteinuria or NS

	1 μgSynacthen Stimulation Test				250μg Synacthen Stimulation Test
	CRF		Proteinuria/NS		CRF		Proteinuria/NS
	n	X±SD	n	X±SD	n	X±SD	n	X±SD
Plasma cortisol
Basal Values	9	18.60±4.79	12	16.47±7.03	9	16.57±4.77	12	14.72±7.61
30 minute	9	30.40±13.68	12	24.30±7.05	9	22.90±6.37	12	25.02±8.48
60minute	9	27.99±11.26	12	23.83±6.20	9	28.37±8.99	12	28.18±10.05
90minute	9	26.38±10.16	12	21.53±5.41	9	31.31±10.56	12	29.18±11.38
120minute	9	27.21±9.13*	12	15.98±2.49	9	33.06±13.73	12	29.73±12.94

p = 0.001 as compared with proteinuria /NS group.

Figure 1. Imagination of a patient's adrenal gland on CT.

Table 5. Computerized Tomography Findings of Patients with Renal Amyloidosisand Healthy Subjects

	Patients with Renal Amyloidosis(n = 20)				HealthySubjects (n = 22)
	MaximumWidth (cm)	Medial Limb Width (cm)	Lateral Limb Width (cm)	AnteriorWidth (cm)	Maximum Width (cm)	MedialLimb Width (cm)	Lateral Limb Width (cm)	Anterior Width (cm)
Right adrenal gland	6.82 ± 2.2710^*	4.52 ± 1.59	3.69 ± 1.23	3.57± 0.71	4.63 ± 1.31	4.11 ±0.82	3.54 ± 0.76	4.55 ± 0.87
Left adrenal gland	8.79 ± 2.6410^*	4.48 ± 1.45	4.30 ± 1.64	5.17 ± 1.6311^**	6.76 ± 1.49	4.09 ± 0.92	3.79± 0.87	4.06 ± 0.75

^*p< 0.01 as compared with healthy subjects.

^**p< 0.05 as compared with healthy subjects.