Stimulatory Effect of Adrenocorticotropin on Cortisol, Aldosterone, and Dehydroepiandrosterone Secretion in Normal Humans: Dose-Response Study*

The short ACTH test is widely used in clinical practice for the diagnosis of adrenal insufficiency. It is classically performed administering 250.0 microg ACTH(1-24) although 1.0 microg ACTH dose has been reported having maximal stimulatory effect on cortisol levels in normal subjects. We aimed to define the maximal and the minimal stimulatory ACTH dose on cortisol, aldosterone, and dehydroepiandrosterone (DHEA) in humans. To this goal, in 12 normal volunteers (6 males and 6 females; age, 22-34 yr; body mass index 20-25 kg/m2; body surface 1.6-1.9 m2), we studied the dose-response effect of eight ACTH doses (0.01, 0.03, 0.06, 0.125, 0.5, 1.0, 25.0, and 250.0 microg) on cortisol, aldosterone, and DHEA levels. Each ACTH dose administered at 0 min was followed by a second ACTH dose of 250.0 microg at +60 min. The cortisol delta areas under response curve (deltaAUCs) after all ACTH doses, apart from 0.01 microg, were significantly higher (P < 0.02) than that after placebo, showing a clear dose-response relationship (P < 0.001). The doses of 0.03 and 1.0 microg ACTH were the minimal and maximal effective doses, respectively. The cortisol response to 250.0 microg ACTH was not modified by pretreatment with 0.01, 0.03, and 0.06 microg ACTH doses, whereas it was progressively reduced by increasing the dose of ACTH pretreatment (P < 0.001). The aldosterone deltaAUCs to all but 0.01 microg ACTH doses were significantly higher (P < 0.02) than that after placebo, showing a clear dose-response relationship (P < 0.001). The dose of 0.03 microg was the minimal effective stimulating dose, whereas 25.0 microg showed the same aldosterone-releasing effect of 250.0 microg. The aldosterone response to 250.0 microg ACTH, preceeded by placebo, was not modified by pretreatment with 0.01 and 0.03 microg ACTH doses, whereas it was reduced by increasing the dose of ACTH pretreatment (P < 0.05-0.02). The DHEA deltaAUCs to all ACTH doses were significantly higher (P < 0.01) than that after placebo, showing a clear dose-response relationship (P < 0.001). The doses of 0.01 and 1.0 microg ACTH were the minimal and maximal effective dose, respectively. The DHEA response to 250.0 microg ACTH was not modified by pretreatment with 0.01, 0.03, 0.06, and 0.125 microg ACTH doses, whereas it was progressively reduced by pretreatment with 0.5, 1.0, and 25.0 microg ACTH doses (P < 0.01). In conclusion, these results show that an extremely low ACTH dose is needed to stimulate adrenal steroids and, among them, DHEA seems the most sensitive to corticotropin stimulation.