Discordant Cortisol Response in Pituitary Disease

To the Editor: Borst and his colleagues have elucidated the potential for underdiagnosis of secondary adrenal insufficiency arising from the use of the short ACTH test in patients with long-standing pituitary disease (June 17 issue). 1 We would add that this caution has special importance in the evaluation of patients immediately after pituitary surgery. Although the suggestion has been made that the results of the short ACTH test and those of the insulin-tolerance test correlate in this setting, 2 we have observed initially discordant cortisol responses to a short ACTH test and an insulin-tolerance test within a week of transsphenoidal surgery, . . . No extract is available for articles shorter than 400 words.