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Gabriel Dickstein, Carmela Shechner, Low Dose ACTH Test—A Word of Caution to the Word of Caution: When and How to Use It, The Journal of Clinical Endocrinology & Metabolism, Volume 82, Issue 1, 1 January 1997, Page 322, https://doi.org/10.1210/jcem.82.1.3704-1
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In 1991 we introduced the low dose ACTH test (1). Since then, numerous papers (2–6) have confirmed our data. Lately, two contradictory letters in JCEM challenged the validity of the test. The first (7), based on feelings rather than facts, suggests that even 1μ g of ACTH might be too high a dose for a physiologic stimulation of the adrenal. The second (8) suggests (based on one case) that 1 μg may in some cases or situations be too low a dose for this purpose.
It is difficult to argue with the first letter (7), as no facts are given. However, while most investigators still use 250 μg ACTH as the adrenal stimulating dose, to speculate that 1:250 that amount is still too high seems speculative. The second letter (8) is based on a bizarre case in which subnormal response to the low dose ACTH test was noticed, but also no response was noticed to CRH, or to insulin challenge. A repeated low dose ACTH test was normal (though no data are given!).
