Impact of glucocorticoid therapy on hypothalamic-pituitary-adrenal axis function in pediatric nephrotic syndrome: A narrative review

Table 1 Tests to detect hypothalamic-pituitary-adrenal axis integrity

Test name	Methods	Expected result
Serum cortisol level	Measurement of early morning between 7:00 am to 9:00 am	Normal: Serum cortisol level ≥ 18 μg/dL. Insufficient: < 3 μg/dL. Indeterminate: 3-18 μg/dL
Insulin tolerance testing	Insulin (0.05 0.15 U/kg IV). Serum measurements of cortisol at 0, 30, 60 minutes	Normal: Peak cortisol ≥ 18 μg/dL. Insufficient: Serum cortisol level < 18 μg/dL
Metyrapone test	Metyrapone 30 mg/kg administered at midnight and measurement of serum cortisol and 11-deoxycortisol at 8:00 the next morning	Serum cortisol < 7 μg/dL confirms enzymatic blockade. Normal: Serum 11-deoxycortisol > 7 μg/dL. Insufficient: Serum 11-deoxycortisol, 7 μg/dL
ACTH stimulation test	Synthetic ACTH (250 μg IV or IM or 1 μg IV). Serum measurements of cortisol at 0, 30, 60 minutes	Normal: Serum cortisol level ≥ 18 μg/dL. Insufficient: Serum cortisol < 18 μg/dL

ACTH: Adrenocorticotropic hormone.