July 4, 1966

Failure of Corticosteroid Test in the Differential Diagnosis of Jaundice

Author Affiliations

From the Fearing Research Laboratory at the Boston Hospital for Women, Parkway Division, Brookline, Mass; and the Department of Obstetrics and Gynecology, Harvard Medical School, Boston. Dr. Loutfi is a fellow of the US Public Health Service (5F3HD24753-02).

JAMA. 1966;197(1):48-49. doi:10.1001/jama.1966.03110010100026

The differential diagnosis of jaundice is often a challenge to the clinician, and in recent years numerous laboratory tests have been proposed. In an analysis of 200 cases of jaundice, Berkowitz1 found an overall diagnostic accuracy of 76% with only a 33% accuracy in cases with intrahepatic obstruction. Steroids and corticotropin were found to be effective in lowering the concentration of serum bilirubin in patients with acute viral hepatitis associated with features suggesting biliary obstruction. Hence it has been suggested that these drugs can be beneficially used under such circumstances as a diagnostic test. Evaluation of the corticotropin (ACTH) test in the differential diagnosis of jaundice2 indicated that this four-day test has a limited usefulness because it shows a moderate overlap between patients with medical and surgical jaundice. More recently, Summerskill et al3 found that a 40% decrease in serum bilirubin concentration occurred in four to six

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