Talk:ACTH stimulation test

Did

Did a heavy copyedit on the content, trying to whip it into shape, but it is still unreferenced and uncategorised. But the content seems to hold some value, even to the lay eye. 9Nak (talk) 14:52, 15 February 2008 (UTC)

Thanks for your help. By the way I've been helping people on forums like this one for over 4 years

http://forums.realthyroidhelp.com/index.php

see hypopituitary forum half way down (I have other articles in the stickies. I won't be posting any of them on Wik as they don't fit on here like acth stim does)

Notes

chemicals that stim to add later

11-DEOXYCORTISOL 0.4 RANGE < 0.8 DHT 72 RANGE 25- 75 17OH PROGESTERONE 2.04 RANGE .61 - 3.34 Aldosterone 32 Range <= 28 i think the range is for the non stimulated. 17-HYDROXYPROGESTERONE 34 RANGE 32- 307 NG/DL 17-OH PROGESTERONE/11-DEOXYCORTISOL 1.5455 RANGE 0.4 - 2.7 11- DEOXYCORTISOL 22 RANGE < OR = 119 NG/DL 18 OH -CORTISOCSTERONE 73 RANGE Upright 5-80 supine 4-37ng/dl

Assessment comments

I'll make some formatting changes in a minute, but here's a quick review:

1.  Done According to WP:LEAD, the introduction is too long. WP:LEAD sets four paragraphs as the maximum size; we have seven. Much of the material could be summarized. For example, the material about interpretation difficulties could be summarized in a single sentence (or half a sentence) along the lines of "Test results are difficult to correctly interpret, particularly for secondary adrenal insufficiency."
2. We need a (short) section on the indications for this test. Much of that material is currently in the introduction.
3.  Done Side effects is a list and, according to the Wikipedia's Manual of Style, should be re-written as a paragraph. It would be nice to have a little more general information. For example, are all the side effects short-term?
4.  Done (new image added to intro) I might move the image up to the top of the introduction. It's not important, but it's the common style.
5.  Done It looks like there are three varieties of this test. Therefore early in the article we need a section that describes the three varieties (what they are, when you'd choose this test over that test, and what information they provide that isn't available in the other versions).
6.  Done Is the aldosterone test actually part of the ACTH test, or is it a separate test that is commonly done at the same time? (Could you do an aldosterone test without doing ACTH simultaneously?)
7.  Done (I made it) If the chart is copied from somewhere, then we need to know what the source is and whether or not it's public domain. We don't want to infringe on someone's copyright.
8.  Done We can shorten the list of See also articles by removing anything that's already properly discussed (and linked) in the text of the article. I've added descriptions to the first two items. This is a "best practice" and very helpful to readers unfamiliar with the topic, because the description helps them figure out which related pages they also want to read.
9.  Done If you aren't aware of WP:MEDMOS and WP:MEDRS, you may find their advice helpful. The first is a style guide for medicine articles (including some suggested topics to include for disease articles), and the second talks about finding good sources for medical information.

Hope this helps, WhatamIdoing (talk) 20:34, 31 August 2008 (UTC)

Suggestions marked with {{done}} template = check for being totally fixed

4. I've been wrestling with that

6. Aldosterone could be tested alone or with cortisol. Cortisol is the primary test. Many hormones and chemicals can be stimmed and are stimmed whether or not they are tested, the question though becomes how to interpret for those other chemicals since there is little to no data on anything besides cortisol, aldosterone and DHEA that I've seen.

7. I made it.

8. I've tried to make sure of there was no duplication. I take another look at it.

Thanks very much. Chrisgj (talk) 22:34, 31 August 2008 (UTC)

Hi Chris, As you can see, I've numbered the comments so you don't have to reply between items.

4. Another option would be to get a general picture of someone getting a blood draw done. That might be more representative of the general concept.

6. From the perspective of the patient, is the aldosterone test the same thing, except that you get two sets of numbers back on the lab report instead of one? There's no extra injection or other difference in the procedure, is there? And if you were doing an aldosterone test on its own, then everything except the actual lab work would be the same as a plain cortisol test, right? WhatamIdoing (talk) 23:24, 31 August 2008 (UTC)

About that image (4): What do you think of Image:Blooddraw.jpg for the lead? WhatamIdoing (talk) 23:27, 31 August 2008 (UTC)

Thanks, been looking for something like that, put in in, what do you think of the size?

6. The test is the same no matter what hormone is going to be tested, is all the same. I'll put that info in later.

8. Fixed it.

Thanks Chrisgj (talk) 00:18, 1 September 2008 (UTC)

4. I think the size of the image is fine. WhatamIdoing (talk) 01:18, 1 September 2008 (UTC)

Ok, I put in bold what I believe is totally fixed. Chrisgj (talk) 01:38, 1 September 2008 (UTC)

I think we're making good progress. About #1, do you think that this page really needs the last short paragraph in the introduction? It doesn't really tell you anything about the test itself. I was thinking that the "potentially life-threatening" bit might move into the proposed new (short) section on ==Indications==, and the "treatment" bit might be moved to Adrenal insufficiency. What do you think? WhatamIdoing (talk) 20:00, 1 September 2008 (UTC)

Sure, it about moving the life threatening to indications and the deal with treatment. A long way to go. I wish I'd found you a lot sooner, could have been done by now (started Feb). I feel like I've wasted a lot of time. Cosyntropin and tetracosactide (chemical names) I very rarely ever see those names used in the 5 years I've been dealing with it. I feel would be best to leave Cortrosyn and Synacthen (trade names), but mentioning those are the more common names used. Chrisgj (talk) 03:20, 2 September 2008 (UTC)

(Undent) As for myself, I've heard of cosyntropin but never the other one (by either generic or brand name). Wikipedia has a strong preference for avoiding brand names unless they're really widely known (at the "Viagra" level). But they're linked, and the most common brand name is usually in the first sentence of the drug article, so people will be able to figure it out. Remember that Wikipedia:There is no deadline. WhatamIdoing (talk) 03:48, 2 September 2008 (UTC)

Synacthen is as well known in our circle as Viagra is to the general public. A newby is 100 times more likely to see Synacthen mentioned over anything else. Cortrosyn is the next common. The other two as I said, are hardly ever seen. These are not preferances, just telling you what I know. Chrisgj (talk) 05:47, 2 September 2008 (UTC)

I'm sure that's true, but officially it doesn't matter. Wikipedia is written for the general reader, not for patients or other "insiders". However, we can ignore the official rules at least to a limited extent. A standard way to do this is to say "generic (Brand Name)" at one of the first mentions in the text. WhatamIdoing (talk) 14:55, 2 September 2008 (UTC)

I've gone through the list and marked off the items that are at least started, even if we have plans to improve them. Everything will need a good copyedit at some point, but right now you're right to focus more on facts and sources. WhatamIdoing (talk) 04:30, 2 September 2008 (UTC)

Ok, I confess I still have to look at the links in number 9. Chrisgj (talk) 05:47, 2 September 2008 (UTC)

I thought I'd mark it off anyway, since it isn't really a specific "thing to do in the article". You can remove the checkmark if that would help you. WhatamIdoing (talk) 14:55, 2 September 2008 (UTC)

Versions

The Endotext.com source says that the low-dose test is better at detecting partial insufficiencies. Is this generally accepted? If we can add any information about why you'd choose one over the other, that would be appropriate to include, I think. WhatamIdoing (talk) 04:46, 2 September 2008 (UTC)

ISBN 9781588291936 (page 261: it's available at books.google.com ) seems to agree. WhatamIdoing (talk) 05:24, 2 September 2008 (UTC)

Remove lead picture

• I don't think the lead picture is terribly relevant to the article. It's just a picture of a generic blood draw. I understand that a blood draw is a component of the ACTH stimulation test, but it's not really helping anyone understand what the test is. If we can't come up with a decent lead picture, then it's probably fine to not have one at all. Chaldor (talk) 01:39, 11 September 2008 (UTC)

The image communicates some information and might be useful to a person that has very weak medical-English language skills. There really isn't a photo that will communicate a lot of information about the test: You draw some blood, get stuck by another needle, wait for 30-60 minutes, and draw some more blood. Overall, though, it's probably slightly better to have that little bit of information than to not have that little bit of information. WhatamIdoing (talk) 02:59, 12 September 2008 (UTC)

• I can certainly understand that train of thought. It clearly comes from one who has been in the medical world for some time. However, if that's the extent we're going to justify the picture's relevance, allow me then to offer a similarly far-reaching counterpoint. There is a rather overt and striking fear of needles/blood in the lay-public. Is it not reasonable then to think that an individual with weak medical-English would be more frightened (and thus less likely to read the article) than informed by the picture of venipuncture? To be perfectly honest, part of my motivation for proposing the removal of the image was this reason precisely. Because of its marginal contribution to the article, and the relative squeamishness of the general public (i.e. those not desensitized to the sight of needles/blood), I felt it would improve the overall readability of the article. Chaldor (talk) 03:16, 12 September 2008 (UTC)

I've never been squeamish that way myself, although I don't want to watch the needle go through my skin, and I don't know how common that feeling is. Perhaps someone else will have an opinion? WhatamIdoing (talk) 17:44, 12 September 2008 (UTC) (who is not a licensed healthcare professional, BTW.)

Third opinion

Hello! The reader is the important thing in any encyclopaedia. Every thing we encyclopaedists do is for their benefit. Images aid comprehension. An image would aid comprehension for this article. This test is a blood test. My question is, if not this image, which? fr33kman -s- 04:37, 27 September 2008 (UTC)

Third opinion (edit conflict)

I agree that the picture contributes only marginally to the article. But it does contribute. When I first saw it, I thought, "oh, this is a medical procedure that involves drawing blood." That is useful information to know, particularly for someone looking for information about this procedure. I do think it shouldn't be given such prominence, however. Don't assign a size, make it default thumb size, and shorten the caption.

Regarding to the point about fear and squeamishness: See Wikipedia:Wikipedia is not censored. The lead pictures on articles such as vulva, breast, and autofellatio might offend, disgust, or shock some people. Even the pictures (after the lead) in Muhammad offends some Muslims. That doesn't really matter, you can't please everybody. If the lead picture enhances the encyclopedic value of the article, it should be there. =Axlq 04:45, 27 September 2008 (UTC)

Agree! :-) fr33kman -s- 05:19, 27 September 2008 (UTC)

Wasn't sure

Since I wrote it, I am not a third opinion I know. I thought Chaldor might have a valid point, but wasn't sure myself, but after reading the other arguements for it, I'm more sure now. In helping with this test, I've found many people don't get that it is a simple, no big deal blood test even after it is explained to them. A picture in this case is needed I think. Chrisgj (talk) 15:09, 27 September 2008 (UTC)

All patients are different. Some will fully understand with just a quick verbal explanation and some will require a basically worded step-by-step guide to the test; pictures always aid comprehension. If you up for a fun challenge, try creating this article over at the Simple English Wikipedia simple:ACTH stimulation test. Writing an article without being allowed to use technical terms (unless fully explained in basic English) is a great exercise in understanding from a patient's viewpoint. :-) I'm a medical student and it's something I come up against every day on the wards. :-) Happy Editing! fr33kman -s- 16:39, 27 September 2008 (UTC)

How To

THis article reads dangerously like a handbook for how to perform this test and interpret its results. Statements do not appear adequately attributed in text to reliable source.

Example:

The person must fast at least 8 hours before the test which should be started by 10 am, but as close to 7 am as possible.[9] The test shouldn't be given if on glucocorticoids, pregnenolone, or adrenal extract supplement as these will affect test results.

This overly uses an instructional tone ("must", "should") and doesn't give any indication as to what authority these directives are coming from (certainly not wikiepdia/ns, 'cos they don't have any).--ZayZayEM (talk) 06:20, 31 October 2008 (UTC)

Appropriately might be:

In order to prepare for the test, patients are required to fast 8 hours before the test.[source] Source Organization recommends that testing be conducted before 10 am, and as close to 7 am where possible.[source] Source Organisation/Clinical data paper shows that glucocorticoids, pregnenolone, or adrenal extract supplements can affect results [source].

{{sofixit}}.

Cheers, WhatamIdoing (talk) 17:28, 31 October 2008 (UTC)

---

I'm also surprised by the explicit reference to a diagnosis of primary insufficiency when base cortisol is under 20 and doesn't double in an hour. With no source at all. I would certainly like a source, and I think the endo who did my test would like that source too (getting him to pay attention - another story, and not germane to WP at all). —Preceding unsigned comment added by 216.9.143.185 (talk) 07:28, 11 August 2009 (UTC)

Incorrect Info

The "Interpretation of Results" section is incorrect per every cited source in this article.

A normal response to ACTH is a peak cortisol level > 20 ug/dL, and an increase of at least 7 ug/dL above the baseline level.

Baseline levels are:

8-10am 4.6 - 20.6 ug/dL 4-6pm 1.8 - 13.6 ug.dL

Patients with Primary Adrenal Failure (Addison's disease) show no response to ACTH.

Per Quest Diagnostics Testing Manual for Cortisol Stimulation, test 41012A.

This information is also verified by all sources listed in the original article. —Preceding unsigned comment added by Special:Contributions/ ([[User talk:|talk]]) 04:41, 4 November 2010 (UTC)

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