Most tests previously employed to prove or disprove the presence of adrenal cortical insufficiency were, by their nature, indirect and depended on general metabolic or hematologic alterations which occur in the organism deficient in adrenal cortical hormones. Unfortunately, from a diagnostic point of view, the stress of nonspecific illnesses increases the demand for cortical hormone. False-positive water-loading tests and saltdeprivation tests are frequently seen in a variety of illnesses. Furthermore, the mere measure of the concentration of steroids in urine or blood frequently fails to differentiate those persons with adrenal insufficiency from those with intact adrenals. Apparently this is due to the considerable individual physiologic variations in excretion of steroid in health and in disease. To overcome this difficulty and still provide a direct and objective test of adrenal function, it is possible to combine the use of corticotropin (ACTH) with methods which measure the concentration of adrenal hormone. In
ENGBRING NH, TRUITT RB, ENGSTROM WW. Evaluation of Adrenal Cortical Function by Stimulation with Corticotropin (ACTH). AMA Arch Intern Med. 1956;98(3):257–265. doi:10.1001/archinte.1956.00250270001001
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