Low-Dose ACTH Stimulation Test in Obesity: A Randomized Dose Assessment.

Mancillas-Adame LG, Sánchez-García A, Rodriguez-Gutierrez R, Gonzalez-Velazquez C, Lavalle-Gonzalez FJ, Zuñiga-Hernandez JA, Rios-Ortega AG, González-González JG

International journal of endocrinology19 Nov 2022Cited by 3 (Europe PMC)

PMID36457351PMCIDPMC9707648DOI10.1155/2022/7860272PepBankPUB-36457351

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Summary

BackgroundThe short cosyntropin test is widely used for adrenal insufficiency screening and diagnosis. Lower cosyntropin doses may have greater sensitivity vs. the standard dose in detecting adrenal dysfunction. Obesity and overweight are increasing, impacting the clinical presentation of some diseases. Currently more than 50% of the subjects diagnosed with autoimmune adrenal insufficiency have a BMI greater than 25, and hence individuals living with overweight and obesity are more frequently requiring evaluation of the adrenal cortical function. Fixed-dose cosyntropin stimulation may not be appropriate for individuals with obesity.ObjectiveThe primary objective was to compare cortisol response to a weight-adapted cosyntropin dose vs. a fixed low dose (1 µg) and a more physiologically fixed dose (10 µg).MethodsTwenty individuals with obesity and 20 age-matched healthy controls underwent in a randomized sequence at least one-week apart, to the The short cosyntropin test with three different doses, 0.2 µg/kg of body weight, 1 or 10 µg fixed dose stimuli. The assessment and data analysis were blinded to the individual and the investigator.ResultsCortisol response was reduced in the group with obesity with the 1 µg fixed dose stimuli at 30 minutes (median, IQR) 649.6 µg, 567.3-738.4 µg for the control group vs. 568.6 µg, 528.4-623.13 µg, p=0.04; there was a lower cortisol peak at 60' in all the three evaluated doses, with a dose-dependent trend. A weight-adapted cosyntropin dose of 0.2 µg in obesity produces a similar response to the one observed in individuals without obesity. The 1 µg ACTH test falls short on stimulating the cortisol adrenal response in individuals with obesity.

CC BYText from Europe PMC. Highlighted sentences are the source of results.

Results from this study3

No result from this study comes from a test of the peptide.

Studies that did not test the peptide alone3

In this study, Cosyntropin was a lab tool or a carrier, part of a mix, or the subject of a lab method. These results are not evidence about taking Cosyntropin.

01HumanNot a test of Cosyntropin aloneObservational studyActivity measurement
After the low fixed cosyntropin dose, cortisol response was lower with obesity: median 568.6 versus 649.6 µg in controls (p=0.04).
In plain wordsAfter low-dose cosyntropin testing, people with obesity had lower cortisol responses than controls.
Peptide
Cosyntropin
Outcome
DecreaseCortisol response at 30 minutes with low fixed dose
Study
n = 40
Comparator
Individuals without obesity
Outcome group
Stress hormones · Endocrine and hormones
Measurements
Median cortisol response at 30 minutes
649.6 µg
control group, 1 µg dose, IQR 567.3-738.4 µg
Median cortisol response at 30 minutes
568.6 µg
obesity group, 1 µg dose, IQR 528.4-623.13 µg
Source sentences
Summary
Cortisol response was reduced in the group with obesity with the 1 µg fixed dose stimuli at 30 minutes (median, IQR) 649.6 µg, 567.3-738.4 µg for the control group vs. 568.6 µg, 528.4-623.13 µg, p=0.04;
2 context sentences(design, population, supporting numbers)
Summary · context
Twenty individuals with obesity and 20 age-matched healthy controls underwent in a randomized sequence at least one-week apart, to the The short cosyntropin test with three different doses, 0.2 µg/kg of body weight, 1 or 10 µg fixed dose stimuli.
Summary · context
The assessment and data analysis were blinded to the individual and the investigator.
In this study, Cosyntropin was a lab tool or a carrier, part of a mix, or the subject of a lab method. This result is not evidence about taking Cosyntropin.
Show in the study text Report a problemFND-3645735101
02HumanNot a test of Cosyntropin aloneObservational studyActivity measurement
In adults with obesity, the cortisol peak at 60 minutes was lower than in controls at all three tested cosyntropin doses (0.2 µg/kg, 1 µg and 10 µg), with a dose-dependent trend.
In plain wordsIn people with obesity, peak cortisol after cosyntropin testing was lower than in controls at all three doses, with a dose-dependent trend.
Peptide
Cosyntropin
Outcome
DecreaseCortisol peak at 60 minutes across the three doses
Study
n = 40
Comparator
Individuals without obesity
Outcome group
Stress hormones · Endocrine and hormones
Source sentences
Summary
there was a lower cortisol peak at 60' in all the three evaluated doses, with a dose-dependent trend.
2 context sentences(design, population, supporting numbers)
Summary · context
Twenty individuals with obesity and 20 age-matched healthy controls underwent in a randomized sequence at least one-week apart, to the The short cosyntropin test with three different doses, 0.2 µg/kg of body weight, 1 or 10 µg fixed dose stimuli.
Summary · context
The assessment and data analysis were blinded to the individual and the investigator.
In this study, Cosyntropin was a lab tool or a carrier, part of a mix, or the subject of a lab method. This result is not evidence about taking Cosyntropin.
Show in the study text Report a problemFND-3645735102
03HumanNot a test of Cosyntropin aloneObservational studyActivity measurement
Weight-adapted cosyntropin produced a similar response in participants with and without obesity.
In plain wordsWeight-adapted cosyntropin produced similar responses in people with and without obesity.
Peptide
Cosyntropin
Outcome
Not applicableResponse to weight-adapted dose
Study
n = 40
Comparator
Individuals without obesity
Outcome group
Stress hormones · Endocrine and hormones
Source sentences
Summary
A weight-adapted cosyntropin dose of 0.2 µg in obesity produces a similar response to the one observed in individuals without obesity.
2 context sentences(design, population, supporting numbers)
Summary · context
Twenty individuals with obesity and 20 age-matched healthy controls underwent in a randomized sequence at least one-week apart, to the The short cosyntropin test with three different doses, 0.2 µg/kg of body weight, 1 or 10 µg fixed dose stimuli.
Summary · context
The assessment and data analysis were blinded to the individual and the investigator.
In this study, Cosyntropin was a lab tool or a carrier, part of a mix, or the subject of a lab method. This result is not evidence about taking Cosyntropin.
Show in the study text Report a problemFND-3645735105

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Version history

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Version 2Current
28 Oct 2026, 02:03 UTC
Study results updated
Version 1
27 Oct 2026, 16:37 UTC
First added · source update from Europe PMC

Subjects

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