General Topics

Uses and Precautions of Genomic Medicine | Endocrinology

What is genomic medicine?

Genomic medicine is the study of our genes (DNA) and their communication with our health. Genomics investigates how a person’s biological info can be used to improve their clinical care and health outcomes (for example, through real diagnosis and personalized treatment.

While genetics looks at exact genes or groups of ‘letters’ along the DNA chain, genomics refers to the study of a person’s whole genetic makeup. It is about how they tell and react to each other and is associated with conditions that have a wider variety of triggers, such as diabetes, heart disease, cancer, and asthma.

How is genomics used in medicine?

Diagnosis: For example, when the cause of a variety of symptoms cannot be identified by any other means. Prenatal tests are done during pregnancy, either for screening (in case something is wrong with the baby) or when there is already a family history. Helps parents make informed decisions and plans for the future.

When there is a family history of serious genetic disorders, you can tell prospective parents whether they are carriers or not and if they can pass it on to their children. You can also tell someone if you are likely to develop the inherited condition later in life, even if you don’t have any symptoms yet.

To assess risk: A person’s genetic makeup can show their susceptibility to certain diseases, such as heart disease, stroke, and cancer. Maybe they have high cholesterol levels or have vein problems. Possessing this knowledge means that they can achieve risk through medication, medical intervention, or by making positive existence changes.

Advances in genomic medicine

Several notable advances or achievements in genomic medicine are described below. However, further study of these issues beyond that provided in these summaries is warranted.

Precision medicine: The ultimate goal of precision medicine is that instead of a “one size fits all” approach by disease type, medicine will be based on a genetic understanding of the disease. Precision medicine not only involves studying the genome, but it also considers factors such as where a person lives, what they do, and what their family health history is.

The goal is to develop specific prevention or treatment approaches to help specific people stay healthy or get better rather than relying on approaches that are the same for everyone.

Precautions of genomic medicine

There are many aspects of genomic medicine that society must consider. For example, if a genomic medicine causes a disease with no known treatment, does it make sense to test people for that mutation before they develop symptoms? Also, some mutations cause an increased risk of disease, but that increased risk is very small compared to the risks of other factors such as diet and exercise.

Does it make sense to screen people for these kinds of changes when the change may not cause harm? How should this information be used? It is illegal for health insurance companies and employers to use genetic information to limit eligibility, set premiums, or discriminate against people without symptoms.

What is genetic counselling?

There are several types of service providers. In the UK, for example, the National Health Service employs 90 consultant clinical geneticists in 25 centres. They are supported by hundreds of specifically trained staff.5 Referral is usually done through a general practitioner (GP or family doctor) and is available to those concerned about a serious genetic family condition or a family tendency to develop cancer, or for parents of a child with learning disabilities and other developmental problems seeking expert evaluation.

In places where a public service is not available, or for those who choose to seek private healthcare treatment, check that the clinic you are using has the necessary registration (for example in the UK this is through the Care Commission for Quality, also known as CQC6) and the laboratory is also duly accredited.

Whatever the setting, the appointment may take some time and you may need to bring other members of your family with you. Your medical and family history will be mapped and explored, and you will likely have a medical exam as well. Finding out that there may be a life-changing or limiting condition in your future is a serious and, for some, traumatic experience.

Along with counselling, you may be offered tests (including blood tests), with the option to have them done the same day or, if you need time to think about the possible implications, come back at a later date. Results can take weeks or even months to recover (depending on the rarity of the genetic abnormality and how easy it is to find), but the results of prenatal tests will be returned much sooner.

Aftercare depends on the results and the nature of the test. Some people will be referred back to their family doctor along with all the details, or they can continue to receive treatment in a specialized unit. Those without symptoms will receive support and advice on lifestyle changes to minimize their risk, and advice on how to manage their possible condition in the future.

Several private companies offer genetic testing by mail. It involves taking a cheek swab or a blood sample at a local clinic. Then it is sent to the laboratory. The types of things that are tested include genetic risk for diabetes and heart conditions, as well as information about ancestry. Some companies provide more services than others, with counsellors or other healthcare professionals available to help. Convenient (but not necessarily cheap), it should be remembered that this is genetic testing without the usual level of holistic support found in established clinics.


Preparation of Slit Lamp Exam | Procedure | Ophthalmology

What is the slit lamp exam?

The slit lamp examination is a standard diagnostic procedure, also known as biomicroscopy. A slit lamp combines a microscope with very bright light. The slit lamp exam is usually part of a comprehensive eye exam. The individual will sit in a chair in front of the slit lamp with the chin and forehead supported by a support.

The doctor can use this instrument to observe the eyes in detail and determine if there are any abnormalities. They will be able to discuss the results with the person right away.

Uses of slit lamp examination

Doctors use the slit lamp as part of a comprehensive eye exam to better look at the structures within a person’s eyes. These include the following:

  • Conjunctiva: The conjunctiva is a thin, transparent membrane that covers the white of the eye. It also includes the membranous surface of the inner lids.
  • Cornea: The cornea is the transparent cover of the iris and pupil. It protects the eye and also helps send light through the pupil to the retina at the back of the eye.
  • Eyelids: The eyelids help protect the eyeball from debris or injury. Blinking helps lubricate the eye and prevent it from drying out.
  • Iris: the iris is the coloured portion of the eye. It controls the quantity of light that arrives in the eye by contracting and dilating the pupil.
  • Pupil: The pupil is the black spot in the middle of the eye. It occupancies light to enter the eye and travel to the retina.
  • Lens: The lens is placed behind the iris and focuses light on the retina.
  • Sclera: The sclera is the white portion of the eye. It consists of relatively strong fibrous tissue that helps provide structure and protection to the rest of the eye.
  • Retina: The retina is the tissue in the eye that contains cells that detect light. These cells join nerves that eventually join to form the optic nerve.

Process undergoing slit lamp examination

After the first look into your eyes, your doctor may apply a special dye called fluorescein to make the exam easier. It will be given as an eye drop or on a small, thin strip of paper that touches the white of the eye. The doctor will then manage a series of eye drops that will dilate the pupils. Enlargement will make it easier for the doctor to see the other structures in the eye. The drops take about 20 minutes to work.

Once the person has dilated pupils, the doctor will repeat the eye exam. This period they will grip a particular lens close to the eye.
The procedure does not hurt, although there may be a brief sting during the application of the eye drops. Dilated pupils develop very large, which can make the eyes sensitive to light. This can make driving or outlay time outside painful. However, the eye drops should garb off within a combine of hours, and wearing sunglasses should help during this period.

Slit lamp exam preparation

There is no special preparation for this test. If the doctor plans to dilate the pupils, the person may want to wear sunglasses and arrange a trip home after the test.

Risk factors in the slit lamp exam

A slit lamp exam is generally very safe, although medications that dilate the pupils carry some risks. They can increase eye pressure, causing nausea and eye pain. Anyone experiencing these symptoms should inform a doctor immediately.

Types of slit lamp exam

Other common eye exams include:

Wood’s lamp examination

Wood’s lamp projects ultraviolet light into the eye to reveal any abrasions or scratches on the cornea. Doctors can use this if a slit lamp is not available.

Fundus examination

During a fundus exam, the doctor will use an ophthalmoscope to look inside the eye. Some will use a direct ophthalmoscope, which is a small hand-held instrument with a light on. However, most doctors will use an indirect ophthalmoscope, as they can wear it on the head and it gives them a wider field of view for the exam. The patient will be asked to look into the distance while using the device to examine the internal structures of the eye.


For this process, the doctor will first administer numbing eye drops. The person will sit with their head supported by the slit lamp microscope, and the doctor will place a special contact lens directly over the eyeball. Happens during a slit lamp exam.

You do not need to prepare in advance for a slit lamp exam. Once you are in the exam chair, the doctor will place an instrument in front of you to support your chin and forehead. This helps stabilize the head for the exam. Your ophthalmologist may put drops in your eyes to make any abnormalities on the corneal surface more visible. The drops contain a yellow dye called fluorescein, which washes away tears. Additional drops may also be put in your eyes to allow your pupils to dilate or enlarge.

The doctor will use a low-power microscope, along with a slit lamp, which is a high-intensity light. They will look you in the eye closely. The slit lamp has different strainers to get different views of the eyes. Some doctor’s offices may have devices that detention digital images to track variations in the eyes over time.

Throughout the test, the doctor will examine all areas of your eye, including:

  • Eyelids
  • Conjunctiva
  • Iris
  • Lens
  • Sclera
  • Cornea
  • Retina
  • Optic nerve

Diagnosis in the test

A slit lamp exam can help diagnose the following circumstances:

  • Macular degeneration, a chronic condition that affects the part of the eye responsible for central vision.
  • Detached retina, a condition in which the retina, which is a main layer of tissue at the back of the eye, is shed from its base.
  • Cataracts, a clouding of the lens that damagingly affects the ability to see images visibly.
  • Corneal injury, an injury to one of the tissues that cover the surface of the eye.
  • Retinal vessel obstructions, obstructions in the blood vessels of the eye that can cause a sudden or gradual loss of vision.

Ask your doctor what you are looking for during the exam and what eye conditions you may be at risk for. This test usually has no major side effects. Your eyes may be sensitive to light for a time afterwards, especially if your pupils were dilated. If you start to feel nauseous or have pain in your eyes, return to your doctor’s office as soon as possible. These may be symptoms of increased fluid pressure in the eye, which can be a medical emergency. While the risk of this is small, eye drops used to dilate the eye can rarely cause this to occur.

Abnormal results mean

If the results of your slit lamp exam are abnormal, there can be a variety of conditions, including:

  • Infection
  • Inflammation
  • Increased pressure in the eye
  • Degeneration of the arteries or veins of the eye

For example, if macular degeneration is occurring, the doctor may find drusen, which are yellow deposits that can form in the macula at the beginning of age-related macular degeneration. If your doctor suspects a particular cause of vision problems, she may recommend more tests to get a more definitive diagnosis.


What is Computed Tomography (CT Scan) | Endocrinology

What is computed tomography (CT Scan)?

Computed tomography (CT) is an imaging procedure that uses specialized x-ray equipment to create detailed images or scans of areas inside the body. This is sometimes called a computed tomography or computerized axial tomography (CT) scan.

The word tomography comes from the Greek words tomes (a cut, slice, or section) and graphene (to write or record). Each image created by the CT procedure shows organs, bones, and other tissues in a thin “piece” of the body. All pieces of images produced in CT are like slices of bread – you can view each slice individually (two-dimensional images) or you can view the entire bar (three-dimensional image). Computer programs are used to create both types of images.

Modern CT machines take continuous images in a helical (or spiral) fashion rather than taking a series of images of individual parts of the body, just like the original CT machines. Helical City (also known as Spiral City) has several advantages over older City techniques: it is faster, produces quality 3D images of areas of the body, and can better detect minor abnormalities.

In addition to its use in cancer, CT is widely used in the diagnosis of diseases and conditions of the circulatory (blood) system such as coronary artery disease (atherosclerosis), vascular aneurysms, and blood clots; Spinal conditions; Stones in the kidneys and bladder; Bulbs Inflammatory diseases such as ulcerative colitis and sinusitis.

And injuries to the head, skeletal system, and internal organs. Computed tomography is also used to detect abnormal brain function or deposits in adult patients with cognitive impairment who are being evaluated for Alzheimer’s disease and other causes of cognitive impairment.

Uses of computed tomography

It is useful for:

  • Soft fabric
  • Pelvis
  • Blood vessels
  • Light
  • Abdomen
  • Bones
  • CT is often the preferred way to diagnose many cancers such as liver, lung, and pancreas.

The image allows the doctor to determine the presence and location of the tumor, its size, and how much nearby tissue is affected. A head scan provides important information about the brain, such as whether there is bleeding, arterial swelling, or a tumor.

The CT scan reveals a tumor in the abdomen and any swelling or inflammation in nearby internal organs. It shows the layers of the spleen, kidneys, or liver. Because a CT scan detects abnormal tissue, it can be used to plan for radiation therapy and biopsy, and it provides valuable data on blood flow and other vascular conditions.

It helps the doctor to assess bone diseases, bone density, and the condition of the patient’s spine. It also provides important data on injuries to the patient’s arms, legs, and other skeletal structures. Small bones are also clearly visible, as is the tissue around them.

Risk Factors of CT Scan (computed tomography)

A CT scan contains a small dose of targeted radiation. This level of radiation has not been shown to be harmful even in people who have had multiple scans. The risk of cancer as a result of a CT scan is estimated to be less than 1 in 2,000. The amount of radiation to which a person is exposed is estimated to be equivalent to several months and several years of natural exposure in the environment.

The scan is done only if there is a clear medical reason to do it. The results lead to treatment for serious conditions. By deciding to have a scan, doctors make sure the benefits outweigh any risks. Problems that arise from radiation exposure include cancer and thyroid problems.

It is very rare in adults and not even in children. However, it is more prone to the effects of radiation. This does not mean that health problems occur, but any CT scan should be noted in the child’s medical record. In some cases, a CT scan will only show the required results. For some conditions, an ultrasound or MRI scan may be done.

CT scan is during pregnancy?

Any woman who suspects that she is pregnant should inform her doctor in advance, as there is a risk that the X-rays will harm the fetus. Citing the American College of Radiography, the American Pregnancy Association (APA) states that “radiation dose should not be included in any diagnostic radiograph until it has adverse effects on the fetus or developing fetus.”

However, the APA states that CT scans are not recommended for pregnant women, “unless the benefits clearly outweigh the risk.”

Breastfeeding after CT scan

If breastfeeding requires an iodinated intravenous dye instead of breastfeeding, you should avoid breastfeeding for about 24 hours while the mother is breastfeeding.

Differences between CT Scan and MRI are

  • The CT scan uses X-rays, but an MRI uses magnets and radio waves.
  • Unlike an MRI, a CT scan does not show tendons or ligaments.
  • MRI is good for examining the spinal cord.
  • CT scan is well suited to cancer, pneumonia, abnormal chest x-rays, bleeding in the brain, especially after an injury.
  • The brain tumor is more clearly visible on MRI.
  • CT scan shows organ tears and injuries more quickly, so it is more suitable for injury cases.
  • On a CT scan, the broken bones and vertebrae are more clearly visible.
  • CT scans provide a better image of the lungs and organs in the chest cavity between the lungs.

Preparation of CT scan

When you schedule your CT scan, the hospital or center staff will tell you how to prepare.

What to eat: The staff may instruct you to drink only clear liquids starting at midnight before your appointment. They may also tell you not to eat or drink for at least 4 hours before the scan. For the scans of certain parts of the body, it is better to eat and drink at any time before. Ask your healthcare team for specific instructions for your test.

What to wear: Wear loose-fitting clothing without zippers or metal buttons. All clothing that contains metal and affects the examination should be removed. This includes shirts, bras, and glasses with belts, earrings, snaps, or zippers. If you cannot wear your clothes during the scan, you can wear a hospital gown.

If you need a contrast medium for the scan: You may need a contrast medium when scanning. If so, your doctor may ask you to have a blood test to monitor your kidney function. You can always have a blood test a few weeks before the scan.

Personal medical history or concerns: Be prepared to talk to your healthcare team about these things:

  • All the medications you are taking.
  • If you have a medical problem such as diabetes.
  • Do you have any drug or food allergies?
  • Any allergic reaction to iodine you may have had in the past.
  • Should you take your usual medication on the day of the scan?
  • You may be breastfeeding or pregnant. A CT scan puts the baby at risk.
  • If you have a problem with the test.

Insurance, expenses, and compliance: If you are concerned about the cost of your CT scan, find out ahead of time what your insurance provider will cover. Ask how much you will have to pay. Once you arrive at the doctor’s office or hospital, the staff will ask you to sign a consent form. This form indicates that you understand the advantages and disadvantages of the scan and that you agree to have it.

During the CT scan

  • The patient must lie on a motorized examination table that slides into a donut-shaped CT scanner.
  • In most cases, the patient lies on his back and on his back. But sometimes they have to lie on their stomach or side.
  • After an X-ray image, the bed is moved slightly and then the machine takes another image and. The patient must lie a lot for the best results.
  • During the examination, everyone except the patient leaves the room. The intercom allows two-way communication between the radiographer and the patient.
  • If the patient is a child, parents or adults can stand or sit nearby but should wear a lead apron to avoid radiation exposure.

After a CT scan

If a contrast dye is used in your procedure, it will be monitored over a period of time for side effects or adverse reactions, such as itching, swelling, a rash, or trouble breathing. If you notice any pain, redness, and/or swelling at the IV site after returning home from your procedure, you should inform your doctor as it may indicate an infection or other type of reaction.

Generally, no special care is required after a CT scan. You can resume your normal diet and activities unless your doctor tells you otherwise. Your doctor may give you additional or alternative instructions after the procedure, depending on your specific situation.


Fluorescein Angiography | Procedure and Risks | Ophthalmology

What is a Fluorescein Angiography?

A fluorescein angiogram or fluorescein angiography is a medical procedure in which a fluorescent dye is injected into the bloodstream. The dye highlights the blood vessels at the back of the eye so they can be photographed.

This fluorescein angiography test is often used to monitor eye disorders. Your doctor may order it to confirm a diagnosis, determine an appropriate treatment, or monitor the condition of the vessels in the back of your eye.

How is fluorescein angiography performed?

FA is usually done in your ophthalmologist’s office. It often takes less than 30 minutes. This is what will happen:

  • Your ophthalmologist or an associate will put drops in your eyes to open (widen) your pupil.
  • A yellowish dye (fluorescein) is injected into a vein, usually in the arm. It takes 10-15 seconds for the dye to travel throughout your body. Over time, the dye reaches the blood vessels in the eye, causing them to “fluoresce” or glow.
  • As the dye clearances through your retina, a particular camera takes pictures. These imageries help your ophthalmologist see any difficulties or where to focus on treatment.

Fluorescein angiography used to

AF is often recommended to find and diagnose eye diseases that include:

  • Macular edema (swelling in the retina that distorts vision)
  • Diabetic retinopathy (damaged or abnormal blood vessels in the eye caused by diabetes)
  • Macular degeneration
  • blockage of the veins within the eye, called BRVO or CRVO
  • Macular fold (a wrinkle on the retina caused by a buildup of fluid behind it)
  • Ocular melanoma (a type of cancer that affects the eye)

FA is also used to:

  • Track changes in eye disease over time
  • Target treatment areas

Test administered in fluorescein angiography

Your doctor will perform the test by inserting standard dilating eye drops into your eyes. These make your pupils dilate. Then, you will be asked to rest your chin and forehead against the camera supports so that your head remains still throughout the test.

Then your doctor will use the camera to take many pictures of your inner eye. After your doctor has completed the first batch of images, they will give you a small injection into a vein in your arm. This injection contains a dye called fluorescein. Then your doctor will continue to take pictures as the fluorescein moves through your blood vessels to your retina.

Side effects and risks of fluorescein angiography

You may have about side effects from fluorescein angiography. This is what you may notice:

  • When you look at objects, they may appear dark or tinted. This side effect disappears in a few minutes.
  • Your skin may look a little yellow. This happens because the dye travels to all the veins in your body. Your skin will arrive at its normal colour in a few hours.
  • Your urine may aspect orange or dark yellow for up to 24 hours. This is because your kidneys will filter the dye from your blood.
  • You may feel a skin burn if the dye leaks out during the injection. This side effect disappears in a few minutes.

Although rare, there is a risk that you may have an allergic reaction to the fluorescein dye. People allergic to the dye may have hives or itchy skin. Very rarely, a person may have breathing problems or other serious problems. Your doctor can treat an allergic reaction with pills or injections.

Although rare, there is a risk that you may have an allergic reaction to the fluorescein dye. People allergic to the dye may have hives or itchy skin. Very rarely, a person may have breathing problems or other serious problems. Your doctor can treat an allergic reaction with pills or injections.

Understanding the results

Normal results

If your eye is healthy, the blood vessels will be normal in shape and size. There will be no blockages or leaks in the vessels.

Abnormal results

Abnormal results will reveal a leak or blockage in the blood vessels. This may be due to:

  • A circulatory problem
  • Cancer
  • Diabetic retinopathy
  • Macular degeneration
  • Hypertension
  • A tumor
  • Enlarged capillaries in the retina
  • Swelling of the optic disc

Expectation after the fluorescein angiogram test

Your pupils may remain dilated for up to 12 hours after the test is done. Fluorescein dye can also make your urine darker and orange for a few days.

Test addresses

Your doctor may recommend a fluorescein angiogram to determine if the blood vessels in the back of your eye are receiving adequate blood flow. It can also be used to help your doctor diagnose eye disorders, such as macular degeneration or diabetic retinopathy.

Macular degeneration

Macular degeneration occurs in the macula, which is the part of the eye that allows you to focus on fine details. Sometimes the disorder worsens so slowly that you may not notice any changes at all. In some people, it causes vision to deteriorate rapidly and blindness can occur in both eyes.

Because the disease destroys your focused central vision, it prevents you from:

  • See objects clearly
  • Drive
  • Reading
  • Watching television

Diabetic retinopathy

Diabetic retinopathy is caused by long-term diabetes and results in permanent damage to the blood vessels in the back of the eye or the retina. The retina converts the images and light that enter the eye into signals, which are then transmitted to the brain through the optic nerve.

There are two types of this disorder:

  • Non-proliferative diabetic retinopathy, which occurs in the early stages of the disease
  • Proliferative diabetic retinopathy, which develops later and is more severe

Your doctor may also order a fluorescein angiogram to see if treatments for these eye disorders are working.

Preparation for the fluorescein angiogram test

  • You will need to arrange for someone to pick you up and drive you home, as your pupils will be dilated for up to 12 hours after the test.
  • Be sure to inform your doctor before the test of any prescriptions, over-the-counter medications, and herbal supplements you are taking. You should also inform your doctor if you are allergic to iodine.
  • If you wear contact lenses, you will need to remove them before the test.

The risks in the tests

The most common reaction is nausea and vomiting. You may also experience dry mouth or increased salivation, increased heart rate, and sneezing. In rare cases, you may have a severe allergic reaction, which may include the following:

  • Swelling of the larynx
  • Hives
  • Laboured breathing
  • Fainting
  • Heart attack

If you are pregnant or think you may be, you should avoid having a fluorescein angiogram. The risks to the unborn fetus are unknown.


Overview of ACTH stimulation test (Cosyntropin)| Endocrinology

What is the ACTH stimulation test (cosyntropin)?

The ACTH stimulation test, which assesses the hypothalamic-pituitary-adrenal axis, is a great tool in the diagnosis of adrenal insufficiency, although it does not usually distinguish the pituitary from the adrenal factor. This dynamic test measures serum cortisol levels before and after a dose of 1 or 250 mcg of ACTH. In patients with normal adrenal function, the cortisol level should be higher than 500 pmol / L 30 minutes after ACTH administration (may be lower in some tests).

A low cortisol level that does not rise after ACTH administration indicates an abnormal cortisol response, which is seen in primary adrenal insufficiency. However, due to adrenal insufficiency with chronic ACTH deficiency, the cortisol response is often abnormal in patients with hypopituitarism.

Your pituitary gland is a pea-sized gland located at the base of your brain. It produces a wide variety of hormones, including adrenocorticotropic hormone (ACTH).

ACTH stimulates the adrenal glands located above the kidneys to release two hormones, cortisol and adrenaline (also known as epinephrine). These hormones help your immune system respond to stress in a healthy way. Cortisol is a steroid hormone that affects many different systems in the body, including:

  • Circulatory system
  • Immune system
  • Nervous system
  • Bone metabolism
  • Metabolism of nutrients such as carbohydrates, fats and proteins.

Adrenaline, or epinephrine, is a hormone used to maintain the normal nervous system and circulatory function. This hormone, along with another hormone called norepinephrine, is responsible for your defence fight or flight response when faced with a stressful situation.

If you suspect that your adrenal glands are not working properly, your healthcare provider may ask you to take an ACTH (cosyntropin) test. For this test, you must receive an injection of coctropin, a synthetic component of ACTH. You will also draw two blood samples, one before the injection and one after the injection. These samples measure the level of cortisol in your blood.

This ACTH stimulation test measures how your adrenal glands respond to ACTH in your blood. It does this by measuring the cortisol levels in your body. It is important not to confuse this test with the ACTH test, which measures the levels of ACTH in your blood.

Why do I need an ACTH stimulant test?

The ACTH stimulation test is used to diagnose adrenal insufficiency, also known as Addison’s disease. It is also used to confirm that the pituitary gland is not working properly due to hypopituitarism. Deficiency can cause secondary adrenal insufficiency as a substitute for cortisol.

As with Cushing’s syndrome, the ACTH stimulation test is used to determine the level of ACTH in the blood, as well as the level of cortisol secretion from the adrenal gland.

Below are some signs and symptoms that may alert your doctor to order an ACTH stimulus test. These codes are specific. However, they should be evaluated if they are progressive and interfere with your daily activities and normal functioning:

  • Unexplained weight loss
  • Low blood pressure
  • Lack of appetite
  • Muscular weakness
  • Muscle and joint pain
  • Fatigue
  • Darkening of the skin
  • Humor changes
  • Disappointment
  • Irritated

Some characteristic signs and symptoms of excessive cortisol secretion are:

  • Acne
  • Round face
  • Is Remaining (around the trunk)
  • Increase in facial and body hair.
  • Structural manipulations in women
  • Low sex drive in men

If you experience these symptoms, your healthcare provider may order an ACTH (cosyntropin) stimulant test. This will help them determine if your symptoms are caused by dysfunctional adrenal glands.

What are the risks of the ACTH stimulation test?

There are some dangers every time you draw blood. In addition to:

  • Mild headache
  • Infection
  • Excessive bleeding
  • Epilepsy
  • Hematoma
  • Inflammation of the vein where the blood draws entered.

You may experience mild to moderate pain when the needle is inserted. You may also feel flushing at the puncture site after the needle has been removed. There may be slight bleeding after the needle is removed and you may develop small lesions in this area. All of these symptoms are limited and do not cause serious permanent effects.

How is the test used?

The ACTH stimulation test may be used to investigate a low cortisol test result. It may be used to help diagnose primary adrenal insufficiency (Addison disease) if your healthcare practitioner suspects that your adrenal glands may not be producing enough cortisol. The test may also be done to help determine whether a condition affecting the pituitary gland is causing low cortisol levels (secondary adrenal insufficiency).

This ACTH stimulation test is used to determine whether your adrenal glands are capable of responding to ACTH and whether this is a typical response. The Endocrine Society recommends using tests for ACTH, aldosterone (also produced by the adrenal glands), and renin (a hormone that controls aldosterone production) as part of the evaluation for primary adrenal insufficiency.

How should I prepare for the ACTH stimulation test?

Preparations for this ACTH stimulation test can vary. Make sure you get clear instructions from your healthcare provider. You will need to fast for eight hours before the test. Your provider may recommend that you stop taking certain medications 24 hours before the test. Some common medications that affect cortisol levels include (but are not limited to):

  • Steroid drugs
  • Male hormones
  • Birth control pills
  • Estrogen
  • Amphetamines
  • Lithium
  • Phenytoin (antiseptic drug)

It is important to make sure your doctor knows all the medications you are taking, including those that are over the counter.

What happens

The test will take place at the T4D Infusion Clinic on the fourth floor of the Tower building at Nationwide Children’s Hospital. Take your child to the Crossroads registration area on the first floor to register before coming to the clinic.

ACTH stimulation test

  • The nurse starts the intravenous (IV) line (Image 1). The nurse may put a numbing cream on the baby’s skin before starting the IV to reduce pain.
  • A blood sample is taken through an IV. The IV is used to draw blood and administer medications.
  • Another name for ACTH is a medicine given by a nurse called short sine. Cortisin is released by the adrenal glands into cortisol.
  • After administration of cortesin, blood samples are taken intravenously.
  • There should be no hassle when drawing blood samples for your child as they are taken from an existing IV.
  • At the end of the test, the IV needle is removed.

How is the ACTH (cosyntropin) stimulation test performed?

Your healthcare provider will take a blood sample when you arrive for your procedure. This blood sample measures your blood cortisol levels. Your doctor can use this sample as a reference to compare the results of a second blood test.

You will receive an injection of coctropin, a synthetic component of ACTH. This hormone must stimulate the adrenal glands to produce cortisol. Wait about an hour while your body responds to the atropine injection.

After this first hour, your healthcare provider will take a second blood sample. This pattern reflects your cortisol levels once your body has time to respond to the injection. Both blood samples will be tested to determine your cortisol levels. Usually, you will get the results of the ACTH stimulation test in one to two weeks.

After the test

  • Your child can eat regular foods.
  • Your child will be able to return to normal activities after the test.
  • Test results take 1 to 2 weeks to return. When the report is ready, your paediatrician will talk with you about the results and future planning.

What do the results of the ACTH stimulation test mean?

Cortisol levels in the blood increase with ACTH stimulation if the adrenal glands are working properly. Test results may vary slightly, so you should check with your doctor if you are concerned.

Cortisol blood levels below the acceptable range after stimulation are considered low. These abnormal ACTH stimulation test results mean you have an adrenal condition such as a severe adrenal crisis, Addison’s disease, or hypopituitarism.

Cortisol blood levels higher than the range after ACTH stimulation may be associated with Cushing’s syndrome. More tests are needed to confirm this diagnosis. This testing process can be complicated, so talk to your healthcare provider about how to proceed.