ALAN N. ELIAS, M.D.; GRANT GWINUP, M.D.
To the editor: We read with interest the article by Koletsky and associates (1) on the cortisol suppression test in patients with elevated adrenocorticotropic hormone (ACTH) levels. In a previous study (2), we showed that cortisol failed to normalize ACTH values in patients with Nelson's syndrome, but was effective in lowering ACTH values after bilateral adrenalectomy for Cushing's disease. The ACTH values were not suppressed in our patients with Nelson's tumor, even when serum Cortisol concentrations were greater than 300 µg/dL, a level much higher than that used by Koletsky and colleagues.
Failure of Cortisol to suppress ACTH secretion from
ELIAS AN, GWINUP G. Cortisol, Valproic Acid, and ACTH Suppression. Ann Intern Med. ;96:786. doi: 10.7326/0003-4819-96-6-786_1
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Published: Ann Intern Med. 1982;96(6_part_1):786.
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