Corticotropin-releasing hormone stimulation test

The corticotropin-releasing hormone (CRH) stimulation test has been used as a diagnostic test in both adrenal insufficiency and Cushing syndrome. In 95% of normal subjects, baseline ACTH increases two- to fourfold within 30-60 minutes of CRH administration 1) 2) 3) 4).

The corticotropin-releasing hormone (CRH) stimulation test is a second-line non-invasive dynamic test for precise localization of disease in which at least a 35-50% increase of ACTH and 20% increase of cortisol concentrations from baseline indicate the pituitary gland as the origin of hypercortisolemia 5) 6) 7).

1)
Grinspoon SK, Biller BM. Clinical review 62: Laboratory assessment of adrenal insufficiency. J Clin Endocrinol Metab. 1994 Oct; 79(4):923-931.
2)
Perry LA, Grossman AB. The role of the laboratory in the diagnosis of Cushing's syndrome. Ann Clin Biochem. 1997 Jul; 34(Pt 4):345-359. PubMed 9247665
3)
Nieman LK, Oldfield EH, Wesley R, Chrousos GP, Loriaux DL, Cutler GB Jr. A simplified morning ovine corticotropin-releasing hormone stimulation test for the differential diagnosis of adrenocorticotropin-dependent Cushing's syndrome. J Clin Endocrinol Metab. 1993 Nov; 77(5):1308-1312.
4)
Trainer PJ, Faria M, Newell-Price J, et al. A comparison of the effects of human and ovine corticotropin-releasing hormone on the pituitary-adrenal axis. J Clin Endocrinol Metab. 1995 Feb; 80(2):412-417.
5)
Invitti C, Pecori Giraldi F, de Martin M, Cavagnini F, Study Group of the Italian Society of Endocrinology on the Pathophysiology of the Hypothalamic-Pituitary-Adrenal Axis Diagnosis and management of Cushing’s syndrome: results of an Italian multicentre study. J Clin Endocrinol Metab. 1999;84(2):440–448.
6)
Nieman LK, Oldfield EH, Wesley R, Chrousos GP, Loriaux DL, Cutler GB., Jr A simplified morning ovine corticotropin-releasing hormone stimulation test for the differential diagnosis of adrenocorticotropin-dependent Cushing’s syndrome. J Clin Endocrinol Metab. 1993;77(5):1308–1312.
7)
Reimondo G, Paccotti P, Minetto M, Termine A, Stura G, Bergui M, Angeli A, Terzolo M. The corticotrophin-releasing hormone test is the most reliable noninvasive method to differentiate pituitary from ectopic ACTH secretion in Cushing’s syndrome. Clin Endocrinol (Oxf) 2003;58(6):718–724.