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Corticotropin Stimulation Test

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121. Unsupported Price Increase Assessment

$13,685 19.1% Copaxone® $1,711 7.8% Prezista®/ Prezcobix® $1,119 16.4% Revlimid® $6,469 25.8% Novolog®/Mix $1,700 13.3% Acthar® $1,110 14.3% Enbrel® $4,807 19.0% Lucentis® $1,695 -64.3% Levemir® $1,091 9.2% Rituxan® $4,384 17.0% Cosentyx® $1,674 15.9% Sprycel® $1,091 14.3% Opdivo® $4,239 4.6% Botox® $1,639 3.8% Cimzia® $1,055 17.8% Keytruda® $4,149 5.4% Mavyret™ $1,599 -- Simponi®/Aria $1,051 17.2% Eylea® $4,077 0.0% Latuda® $1,574 20.8% Rebif® $1,032 15.4% Neulasta® $3,866 14.4% Vyvanse® $1,573 (...) ($39) Revlimid # Victoza $207 Activase/ TNKase ($43) Sensipar # Chantix $206 Sprycel ($70) Avastin # Odefsey $203 Triumeq ($79) Pomalyst # Descovy $198 Simponi/Aria ($106) Acthar # Xolair $183 Xeljanz ($123) Prevnar Family # Afinitor/Disperz $177 Trulicity ($125) Jakafi # Aubagio $162 Jardiance ($204) Fluzone # Prezista/ Prezcobix $133 Cosentyx ($208) Orencia # Gilenya $114 Eliquis ($222) Invega Sustenna/ Trinza # Humalog/Mix $107 Restasis ($267) *In millions. †Exact value provided by Genentech

2020 California Technology Assessment Forum

122. 3 Tesla magnetic resonance imaging with and without corticotropin releasing hormone stimulation for the detection of microadenomas in Cushing's syndrome. (Abstract)

3 Tesla magnetic resonance imaging with and without corticotropin releasing hormone stimulation for the detection of microadenomas in Cushing's syndrome. We sought to determine if higher resolution 3 Tesla (T) magnetic resonance imaging (MRI) with or without ovine corticotropin releasing hormone (o-CRH) stimulation would increase the sensitivity for detection of pituitary microadenomas in ACTH-dependent Cushing's syndrome (CS).We prospectively identified 23 patients over a 2-year period (...) 3T MRI without (P < 0.016) and with o-CRH stimulation (P < 0.013) was significantly more sensitive for detection of pituitary microadenomas than 1.5T MRI for Group 1 (definitive proof of Cushing's disease, n = 10). Group 2 (those in group 1, plus three patients where dynamic/invasive testing suggested pituitary source) also showed a significant (P < 0.012) advantage for 3T. There was no difference between the 3T and the 3T o-CRH examinations for any of the pulse sequences. We did not observe

2010 Clinical endocrinology Controlled trial quality: uncertain

123. Synacthen test

on the morning of the test but bring them with them to take as soon as the test is completed. Estrogen containing medications, including the contraceptive pill and hormone replacement therapy, should be stopped for six weeks prior to measuring serum cortisol. This is because estrogen induces cortisol binding globulin and leads to elevations in measured serum cortisol. Procedure All patients should have had a 9am cortisol taken before the test is arranged. If the level is above 500 nmol/l or below 100 nmol/l (...) the cannula with 2 mls 0.9% sodium chloride and prior to taking blood samples withdraw 2 mls and discard to remove the sodium chloride flush. If cannulated, remove cannula at end of test and patient may then take-omitted medications and go home. Interpretation: Normal response - stimulated plasma cortisol >550 nmol/l, incremental rise of at least 170 nmol/l. | | | | | | | | Diabetesbible is for health professionals

2011 Diabetes Bible

124. Hyponatraemia

water excretion fractional excretion of sodium thyroid-stimulating hormone serum cortisol level and/or adrenocorticotrophic hormone test serum lipids and serum protein electrophoresis CT brain, chest, abdomen/pelvis other tests targeted at evaluating the underlying cause Treatment algorithm ACUTE ONGOING Contributors Authors Associate Director Nephrology MedStar Washington Hospital Center Washington DC Disclosures JHV declares that she has no competing interests. Peer reviewers Director Department (...) 25;170(3):G1-47. http://www.eje-online.org/content/170/3/G1.long http://www.ncbi.nlm.nih.gov/pubmed/24569125?tool=bestpractice.com Hyponatraemia is generally caused by an increase in renal water reabsorption due to release of vasopressin (arginine vasopressin also known as antidiuretic hormone) along with water intake, and can occur in situations of volume depletion, volume overload, or normal volume. (It should be noted that loss of sodium is minor compared with gains in water in most types

2018 BMJ Best Practice

125. Overview of brain tumours

pituitary adenomas. J Clin Endocrinol Metab. 2006 Sep;91(9):3316-23. http://www.ncbi.nlm.nih.gov/pubmed/16787992?tool=bestpractice.com and Carney complex. Beckers A, Daly AF. The clinical, pathological, and genetic features of familial isolated pituitary adenomas. Eur J Endocrinol. 2007 Oct;157(4):371-82. http://www.eje-online.org/content/157/4/371.long http://www.ncbi.nlm.nih.gov/pubmed/17893250?tool=bestpractice.com May present with features of hormonal insufficiency. Most symptoms are longstanding (...) , which stimulates insulin-like growth factor-1 (IGF-1) production, leading to the majority of the clinical manifestations of the acromegaly. Melmed S. Medical progress: acromegaly. N Engl J Med. 2006;355:2558-2573. http://www.ncbi.nlm.nih.gov/pubmed/17167139?tool=bestpractice.com Diagnosis is based on biochemical confirmation of IGF-1 hypersecretion. Treatment includes surgical resection and/or somatostatin analogues. Ben-Shlomo A, Melmed S. Acromegaly. Endocrinol Metab Clin North Am. 2008;37:101-122

2018 BMJ Best Practice

126. Precocious puberty

stimulation test MRI brain CT brain 17-hydroxyprogesterone urinary steroid profile ACTH stimulation test CT or MRI adrenals ultrasound adrenals bone scan/skeletal survey other pituitary hormone investigations genetic testing thyroid function tests overnight gonadotrophin profile Treatment algorithm ACUTE Contributors Authors Paediatric Endocrinologist London UK Disclosures AM is an author of several articles cited within this topic. Professor of Paediatric Endocrinology University College London London UK (...) , or aromatase inhibitors and anti-androgens. Treatment should be stopped once an acceptable age of puberty is reached. Definition Puberty is an interval characterised by the acquisition of the secondary sexual characteristics, accelerated linear growth, increase in the secretion of sex hormones, maturation of gonads (testes in boys; ovaries in girls), and the potential for reproduction. It is typically complete within 2 to 5 years. Precocious puberty should be considered when secondary sexual

2018 BMJ Best Practice

127. Premature ovarian failure

-stimulating hormone (FSH) level serum luteinising hormone (LH) level serum estradiol level anti-Müllerian hormone (AMH) level thyroid function tests serum prolactin level transvaginal ultrasound thyroid peroxidase antibody serum fasting glucose level electrolytes, urea, creatinine karyotype fragile X premutation adrenocorticotropic hormone (ACTH) stimulation test serum adrenal antibodies baseline DEXA scan Treatment algorithm ACUTE Contributors Authors Professor of Obstetrics and Gynaecology Academic Unit (...) dryness. Usually results in infertility, although spontaneous ovulation and pregnancy can occur rarely after its diagnosis. Differential diagnosis includes genetic/chromosomal abnormalities, autoimmune disorders, infections, and toxic and idiopathic causes. Screening for underlying medical conditions is recommended (as is karyotyping), especially in women younger than 30 years of age. Hormone replacement therapy is recommended for treatment of symptoms and prevention of diseases including osteoporosis

2018 BMJ Best Practice

128. Pituitary adenoma

hormone stimulation test (ITT or GHRH/arginine) IGF-1 LH, FSH alpha subunit of human pituitary glycoprotein hormones testosterone estradiol TSH, free thyroxine morning cortisol ACTH stimulation test ACTH insulin tolerance test for cortisol basic metabolic panel FBC MRI pituitary with gadolinium enhancement contrast enhanced CT pituitary lipid panel Humphrey or Goldmann formal visual fields test immunohistochemical staining Treatment algorithm ACUTE ONGOING Contributors Authors Assistant Professor (...) . Differential diagnosis of sellar masses. Endocrinol Metab Clin North Am. 1999 Mar;28(1):81-117. http://www.ncbi.nlm.nih.gov/pubmed/10207686?tool=bestpractice.com They are diagnosed when patients present with hormone hypersecretion, plus visual and neurological deficits and hypopituitarism as a result of mass effect. They may also be found as pituitary incidentalomas. Pituitary adenomas that do not cause a characteristic hormone hypersecretion syndrome (null cell and the majority of gonadotroph adenomas

2018 BMJ Best Practice

129. Multiple endocrine neoplasia syndromes

(MEN1) calcium-stimulated gastrin (MEN1) serum proinsulin (MEN1) serum pancreatic polypeptide (MEN1) serum glucagon (MEN1) T4 (free thyroxine) (MEN1) thyroid-stimulating hormone (TSH) (MEN1) dexamethasone suppression test (MEN1/2) urine sulphonylurea (MEN1/2) metaiodobenzylguanidine scintiscan (MIBG) (MEN2) 18F-fluorodihydroxyphenylalanine positron emission tomography (18F-DOPA PET)/CT abdomen and pelvis (MEN2) technetium 99 sestamibi scintiscan (MEN1/2) abdominal CT (MEN1/2) abdominal MRI (MEN1/2 (...) ) syndromes are hereditary tumour syndromes of variable neoplastic patterns and characterised by the development of multiple endocrine tumours. Tumours can include parathyroid adenomas, pituitary adenomas (which may be non-secretory or affect the profiles of adrenocorticotrophic hormone, growth hormone, TSH, and/or prolactin), enteropancreatic neuroendocrine tumours (which may affect the profiles of gastrin, insulin, glucagon, and/or vasoactive intestinal protein), facial lipomas, facial angiofibromas

2018 BMJ Best Practice

130. Adrenal suppression

weeks non-physiological scheduling of glucocorticoid dose megestrol use medroxyprogesterone use Diagnostic investigations serum comprehensive chemistry panel serum a.m. cortisol salivary a.m. cortisol adrenocorticotropic hormone (ACTH) stimulation test insulin tolerance test (ITT) overnight metyrapone test urine synthetic glucocorticoids Treatment algorithm INITIAL ACUTE ONGOING Contributors Authors Associate Professor Department of Endocrinology Cleveland Clinic Foundation Cleveland OH Disclosures (...) endogenous glucocorticoid excess (e.g., Cushing's syndrome after treatment). Even locally administered glucocorticoids may result in adrenal suppression. The adrenocorticotropic hormone stimulation test is generally the most useful test to detect adrenal suppression. Treatment consists of augmented corticosteroid therapy plus supportive care for any intercurrent stress or overt signs of adrenal insufficiency. Preventive measures include minimising corticosteroid dose and duration when possible

2018 BMJ Best Practice

131. Spontaneous bacterial peritonitis

, lactate dehydrogenase (LDH) ascitic fluid carcinoembryonic antigen (CEA) ascitic fluid alkaline phosphatase CT scan abdomen ascitic fluid lactoferrin ascitic fluid granulocyte elastase (latex immunoassay test) ascitic fluid PCR for bacterial DNA short corticotrophin stimulation test serum procalcitonin Treatment algorithm ACUTE ONGOING Contributors Authors Associate Professor of Emergency Medicine UCSF Fresno Medical Education Program Fresno CA Disclosures BC is an author of a number of references (...) , altered mental status, and GI bleeding. However, patients are commonly minimally symptomatic, and may even be asymptomatic. Ascitic fluid laboratory tests should include cell count and culture. Bedside (standard urine) leukocyte esterase reagent strip testing of ascitic fluid has a role in the rapid diagnosis of spontaneous bacterial peritonitis (SBP); highly-sensitive leukocyte esterase reagent strip testing of ascitic fluid may be used to rule out SBP. Defined by an ascitic fluid absolute neutrophil

2018 BMJ Best Practice

132. Hypopituitarism

and polyuria breast atrophy reduced bone and muscle mass loss of axillary and pubic hair pituitary tumour pituitary apoplexy pituitary surgery cranial radiation traumatic brain injury genetic defects inflammatory disorders hypothalamic disease severe postpartum haemorrhage (Sheehan syndrome) empty sella syndrome tuberculous meningitis syphilis Diagnostic investigations serum electrolytes serum and urine osmolarity 8 a.m. cortisol and adrenocorticotrophic hormone thyroid function tests 8 a.m. testosterone (...) , follicle-stimulating hormone, and luteinising hormone in men estradiol, follicle-stimulating hormone, and luteinising hormone in women prolactin insulin-like growth factor-1 cosyntropin/tetracosactide stimulation test insulin tolerance test water deprivation and desmopressin response test MRI pituitary CT pituitary metyrapone testing of the adrenal axis Treatment algorithm INITIAL ONGOING Contributors Authors Associate Professor of Medicine Medical College of Georgia Augusta GA Disclosures BS declares

2018 BMJ Best Practice

133. Addison's disease

sarcoidosis Diagnostic investigations serum electrolytes blood urea FBC morning serum cortisol adrenocorticotrophic hormone (ACTH) stimulation test serum ACTH plasma renin activity plasma aldosterone plasma dehydroepiandrosterone (DHEA) plasma DHEA sulphate (DHEAS) adrenal antibodies adrenal CT or MRI insulin hypoglycaemia test overnight single-dose metyrapone test Treatment algorithm INITIAL ONGOING Contributors Authors Professor Emeritus and Honorary Consultant Department of Endocrinology and Diabetes (...) Addison's disease Addison's disease - Symptoms, diagnosis and treatment | BMJ Best Practice You'll need a subscription to access all of BMJ Best Practice Search  Addison's disease Last reviewed: February 2019 Last updated: December 2018 Summary Presentation may be acute or insidious, with substantial fatigue and weakness associated with mucocutaneous hyperpigmentation, hypotension and/or postural hypotension, and salt craving. Adrenocorticotrophic hormone stimulation test is performed

2018 BMJ Best Practice

134. Hypoparathyroidism

in thalassaemia metastatic cancer Diagnostic investigations serum calcium serum albumin ECG plasma intact PTH serum magnesium serum 25-hydroxyvitamin D serum phosphorus serum creatinine 24-hour urine calcium, creatinine 24-hour magnesium, creatinine liver function tests arterial blood gases (ABGs) serum free T4, thyrotropin morning cortisol and adrenocorticotropin (ACTH) stimulation testing full blood count serum iron, transferrin, ferritin serum copper ophthalmological examination audiology renal imaging (...) serum calcium in the accident and emergency department or recovery room. Majority of cases are post-surgery for benign and malignant thyroid disorders, hyperparathyroidism, and laryngeal or other head and neck cancers. Nonsurgical aetiologies include: rare genetic conditions and syndromes; autoimmune destruction of the glands; destruction or invasion due to tumour, radiation, or infiltration by iron or copper; hypomagnesaemia and magnesium depletion; and idiopathic. Laboratory testing should confirm

2018 BMJ Best Practice

135. Overview of seizure disorder

by hyperventilation and photic stimulation. EEG is the definitive test. Most typical absence seizures are medically responsive, and childhood absence epilepsy (CAE) tends to remit by adulthood. Typical absence seizures in CAE, juvenile absence epilepsy (JAE), and juvenile myoclonic epilepsy (JME) are treated with anticonvulsants. Glauser TA, Cnaan A, Shinnar S, et al. Ethosuximide, valproic acid, and lamotrigine in childhood absence epilepsy. N Engl J Med. 2010;362:790-799. http://www.nejm.org/doi/full/10.1056 (...) include hormonal therapy (ACTH or corticosteroids) or vigabatrin. Go CY, Mackay MT, Weiss SK, et al. Evidence-based guideline update: medical treatment of infantile spasms. Report of the Guideline Development Subcommittee of the American Academy of Neurology and the Practice Committee of the Child Neurology Society. Neurology. 2012;78:1974-1980. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3369510/ http://www.ncbi.nlm.nih.gov/pubmed/22689735?tool=bestpractice.com Differentiating between syncope

2018 BMJ Best Practice

136. Overview of brain tumours

pituitary adenomas. J Clin Endocrinol Metab. 2006 Sep;91(9):3316-23. http://www.ncbi.nlm.nih.gov/pubmed/16787992?tool=bestpractice.com and Carney complex. Beckers A, Daly AF. The clinical, pathological, and genetic features of familial isolated pituitary adenomas. Eur J Endocrinol. 2007 Oct;157(4):371-82. http://www.eje-online.org/content/157/4/371.long http://www.ncbi.nlm.nih.gov/pubmed/17893250?tool=bestpractice.com May present with features of hormonal insufficiency. Most symptoms are longstanding (...) , which stimulates insulin-like growth factor-1 (IGF-1) production, leading to the majority of the clinical manifestations of the acromegaly. Melmed S. Medical progress: acromegaly. N Engl J Med. 2006;355:2558-2573. http://www.ncbi.nlm.nih.gov/pubmed/17167139?tool=bestpractice.com Diagnosis is based on biochemical confirmation of IGF-1 hypersecretion. Treatment includes surgical resection and/or somatostatin analogues. Ben-Shlomo A, Melmed S. Acromegaly. Endocrinol Metab Clin North Am. 2008;37:101-122

2018 BMJ Best Practice

137. Hypopituitarism

and polyuria breast atrophy reduced bone and muscle mass loss of axillary and pubic hair pituitary tumour pituitary apoplexy pituitary surgery cranial radiation traumatic brain injury genetic defects inflammatory disorders hypothalamic disease severe postpartum haemorrhage (Sheehan syndrome) empty sella syndrome tuberculous meningitis syphilis Diagnostic investigations serum electrolytes serum and urine osmolarity 8 a.m. cortisol and adrenocorticotrophic hormone thyroid function tests 8 a.m. testosterone (...) , follicle-stimulating hormone, and luteinising hormone in men estradiol, follicle-stimulating hormone, and luteinising hormone in women prolactin insulin-like growth factor-1 cosyntropin/tetracosactide stimulation test insulin tolerance test water deprivation and desmopressin response test MRI pituitary CT pituitary metyrapone testing of the adrenal axis Treatment algorithm INITIAL ONGOING Contributors Authors Associate Professor of Medicine Medical College of Georgia Augusta GA Disclosures BS declares

2018 BMJ Best Practice

138. Addison's disease

sarcoidosis Diagnostic investigations serum electrolytes blood urea FBC morning serum cortisol adrenocorticotrophic hormone (ACTH) stimulation test serum ACTH plasma renin activity plasma aldosterone plasma dehydroepiandrosterone (DHEA) plasma DHEA sulphate (DHEAS) adrenal antibodies adrenal CT or MRI insulin hypoglycaemia test overnight single-dose metyrapone test Treatment algorithm INITIAL ONGOING Contributors Authors Professor Emeritus and Honorary Consultant Department of Endocrinology and Diabetes (...) Addison's disease Addison's disease - Symptoms, diagnosis and treatment | BMJ Best Practice You'll need a subscription to access all of BMJ Best Practice Search  Addison's disease Last reviewed: February 2019 Last updated: December 2018 Summary Presentation may be acute or insidious, with substantial fatigue and weakness associated with mucocutaneous hyperpigmentation, hypotension and/or postural hypotension, and salt craving. Adrenocorticotrophic hormone stimulation test is performed

2018 BMJ Best Practice

139. Hydrocortisone (Alkindi) - Adrenal Insufficiency

. Conclusions on clinical safety 49 2.5. Risk Management Plan 49 2.6. Pharmacovigilance 50 2.7. Product information 50 2.7.1. User consultation 50 Assessment report EMA/4145/2018 Page 3/59 3. Benefit-risk balance 51 4. Recommendation 58 5. Appendix Error! Bookmark not defined. Assessment report EMA/4145/2018 Page 4/59 List of abbreviations ACTH Adrenocorticotropin ADME Absorption, distribution, metabolism and excretion AhR Aryl hydrocarbon receptor AI Adrenal insufficiency ARNT AhR Nuclear Translocator AUC (...) Congenital adrenal hyperplasia CBG Cortisol-binding globulin CEP Certificate of Suitability of the EP CHMP Committee for Medicinal Products for Human Use CI Confidence interval CL/F Clearance C max Maximum concentration CRH Cortico-releasing hormone CRO Contact Research Organisation CV% Coefficient of variation CVMP Committee for Veterinary Medicinal Products EDQM European Directorate for the Quality of Medicines EMA European Medicines Agency EU European Union GC Gas Chromatography GCLP Good Clinical

2018 European Medicines Agency - EPARs

140. Screening and Management of the Hyperandrogenic Adolescent

ofnonclassiccongenitaladrenalhyperplasia.Supplemen- tal testing includes a corticotropin (formerly adrenocor- ticotropic hormone [ACTH]) stimulation test for confirmation of nonclassic congenital adrenal hyperpla- sia and DHEAS to rule out adrenal neoplasm; this may be appropriate in cases of rapid onset of virilization (15). Computed tomography scans to evaluate the adrenal glands should be obtained for patients with markedly elevated DHEAS levels. Alternatively, adrenal ultraso- nography can be offered if adrenal glands can be visual- ized (...) ), location, and quality (comedonal, inflammatory [including erythematous papules and pustules or nodules], or mixed). There is no universally agreed upon grading scale (8). Figure 1. Evaluation and Management of Clinical Hyperandrogenism. Abbreviations: BMI, body mass index; BP, blood pres- sure;CAH,congenitaladrenalhyperplasia;DHEAS, dehydroepiandrosteronesulphate; FSH, follicle-stimulating hormone; HA, hyperandrogenism; LH, luteinizing hormone; 17OHP, 17-a-hydroxyprogesterone; PCOS, polycystic ovary

2019 American College of Obstetricians and Gynecologists

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