A comparison between the effects of low (1 microg) and standard dose (250 microg) acth stimulation tests on adrenal cortex functions with leprosy patients.

Leprosy is a chronic granulomatous disease that either remains localized or widespread depending on the immunological status of the affected patient. It can lead to clinical or subclinical adrenal failure by influencing adrenal steroidogenesis. In the present study, 26 patients (21 males and 5 females) who were diagnosed with lepromatous leprosy and 15 healthy individuals who were compatible with the patients in terms of age and sex were subjected to an adrenocorticotrophic hormone (ACTH) stimulation test. The leprosy and control groups were subjected to 1microg low dose (LDT) and 250 microg intravenous standard dose (SDT) ACTH stimulation tests after 12-hour nocturnal fasting with an interval of three days. Cortisol responses in 0, 30, and 60 minutes were examined. There was no difference between leprosy and control groups in terms of mean baseline cortisol values. Mean value of the peak cortisol response to both LDT and SDT was found to be significantly lower in the leprosy group than in the control group (p < 0.001 and p < 0.01, respectively). Peak cortisol response to LDT in the leprosy group was found below 20 microg/dL in 9 patients (34.6%). As for the peak cortisol response to SDT, it was lower than 20 microg/dL, in 5 patients (19.23%). It was found that LDT response was abnormally low in 4 patients (15.38%) who responded normally to SDT. It was observed that there could be a decrease in adrenocortical reserve capacity although baseline adrenocortical functions were normal in patients with leprosy. It was seen that LDT was more sensitive than SDT in identifying this decrease.