The hormonal and radiological, evaluation of adrenal glands, and the determination of the usefulness of low dose acth test in patients, with renal amyloidosis

Amyloidosis is a multisystem disease which may cause organ loss. Renal invo lvement is the most common clinical problem in amyloidosis, however involve ment of endocrin organs is possible. In this study to assess adrenocortical function and to evaluate the usefulness of low dose ACTH test in patients with renal amyloidosis, we determined cortisol, 17-hydroxyprogesteron (17-O HP) and 11-deoxycortisol (11-DOC) responses to both 1 mug and 250 mug Synac then. We also determined the size of adrenal glands radiologically by using computerized tomography. Twenty one patients with renal amyloidosis and 16 healthy subjects for hormonal evaluation, and 20 patients with renal amylo idosis and 22 healthy subjects for radiologic evaluation were included in t he study. In four patients (19%) peak serum cortisol levels following stimu lation with the low dose of Synacthen were less than 20 mug/dL (550 nmol/L) . Two of them had also subnormal cortisol response to the 250 mug Synacthen stimulation test. Basal and stimulated levels of 11-DOC were lower than th ose of control values (p = 0.000 and p < 0.01 respectively). The mean 11-DO C responses to stimulation with 1 mug Synacthen were also significantly low er than the values obtained after the simulation with 250 mug Synacthen (p < 0.01 and p = 0.000). Cortisol responses to the stimulation with 250 go, S ynacthen were also lower than the control responses (p < 0.05). 17-OHP resp onses were similar to the control values in both tests. In the radiological evaluation them mean maximum width of right adrenal glands and the mean an terior and maximum width of left adrenal glands were significantly greater in the patient group (p < 0.01). In conclusion, adrenal involvement and adr enal insufficiency is common in amyloidosis. Low 11-DOC levels in amyloidos is is a new finding and further detailed studies is required to explain its cause.