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Decreased Plasma Cortisol in Response to Intramuscular ACTH in Ocular Hypertensives and Primary Open-angle Glaucomas

Schwartz, Bernard MD, PhD; Rabin, Paul A. MD; Wysocki, Alice BS; Martin, Jeff MA

doi: 10.1097/IJG.0b013e3180334ff6
Original Studies

Purpose To determine if there is a difference in response of the adrenal gland to intramuscular adrenocorticotropic hormone (ACTH) between normals and ocular hypertensives (OHs) plus primary open-angle glaucomas (POAGs) without pigmented angles.

Methods Intramuscular ACTH was given to 29 normals and 24 OH plus POAG hospitalized in a Clinical Study Unit. Blood samples were obtained at baseline (0 hours) before administration of intramuscular ACTH and 4, 8, and 24 hours after administration of intramuscular ACTH for analysis of plasma cortisol/body mass index (BMI).

Results The OH plus POAG group showed lower cortisol/BMI values compared with the normal group at 4, 8, and 24 hours with a significantly lower peak/BMI value (P=0.030). Multivariate analyses with the peak plasma cortisol/BMI level as the dependent variable showed that a lower peak plasma/BMI was associated with the OH plus POAG group. Also, a lower peak plasma cortisol/BMI level was associated with a lower 0-hour cortisol/BMI (Log).

Conclusions Compared with normals, the OH plus POAG subjects showed lower plasma cortisol levels in response to intramuscular ACTH. This observation suggests adrenal suppression in the OH plus OAG group.

*Glaucoma Research, Inc

Tufts University School of Medicine, Boston, MA

Supported in part by grants EY 00024 and EY 00054 from the National Eye Institute and RR 00054 from the General Clinical Research Centers Branch of the National Institutes of Health, Bethesda, MD and Eye Bank for Sight Restoration, New York, NY.

Requests: Bernard Schwartz, MD, PhD, 7 Kent Street, Suite 3, Brookline MA 02445 (e-mail:

Received for publication March 16, 2006; accepted January 3, 2007

Copyright © 2007 Wolters Kluwer Health, Inc. All rights reserved.