Open AccessOccult Adrenal Insufficiency in Renal Amyloidosis Patients
Author(s) -
Didem Turgut,
Serhan Pişkinpaşa,
Havva Keskin,
Kemal Ağbaht,
Ezgi Çoşkun Yenigün,
Fatih Dede
Publication year - 2021
Publication title -
medeniyet medical journal
Language(s) - English
Resource type - Journals
eISSN - 2149-2042
pISSN - 2149-4606
DOI - 10.5222/mmj.2021.93902
Subject(s) - medicine , adrenal insufficiency , amyloidosis , endocrinology , proteinuria , acth stimulation test , occult , stimulation , adrenocorticotropic hormone , hydrocortisone , transcortin , kidney , globulin , pathology , hormone , alternative medicine
Objective: Systemic amyloidosis may affect many organs, and may cause endocrinologic problems which may result in adrenal insufficiency. However, assessment of adrenocortical reserve is challenging in amyloidosis patients with renal involvement. We aimed to evaluate adrenocortical reserve with various methods of cortisol measurement to determine any occult clinical condition. Methods: Patients with renal amyloidosis and healthy subjects were evaluated in this cross-sectional study. Basal cortisol, corticosteroid-binding globulin (CBG), and albumin levels were measured. Serum free cortisol (cFC) level was calculated. Cortisol response tests performed after ACTH stimulation test (250 μg, intravenously) were evaluated, and free cortisol index (FCI) was calculated. Results: Twenty renal amyloidosis patients, and 25 healthy control subjects were included in the study. Patients and control subjects had similar median serum baseline cortisol levels [258 (126-423) vs 350 (314-391) nmol/L, p=0.169)] whereas patients’ stimulated cortisol levels at the 60th minute were lower [624 (497-685) vs 743 (674-781) nmol/L, p=0.011)]. The 60th-minute total cortisol levels of 8 of the 20 (40%) amyloidosis patients were <500 nmol/L, but only three of these 8 patients had stimulated FCI <12 nmol/mg suggesting an adrenal insufficiency (15%). Conclusion: ACTH stimulation test and cortisol measurements should be considered in renal amyloidosis patients with severe proteinuria to avoid false positive results if only ACTH stimulation test is used. It will be appropriate to evaluate this group of patients together with estimated measurements as FCI.