Role of sampling times and serum cortisol cut-off concentrations on the routine assessment of adrenal function using the standard cosyntropin test in an academic hospital from Spain: a retrospective chart review.

Autor:	Ortiz-Flores AE; Department of Endocrinology and Nutrition, Hospital Universitario Ramón y Cajal, Madrid, Spain.; Diabetes, Obesity and Human Reproduction Research Group, Hospital Universitario Ramón y Cajal & Universidad de Alcalá, Instituto Ramón y Cajal de Investigación Sanitaria (IRYCIS), Centro de Investigación Biomédica en Red Diabetes y Enfermedades Metabólicas Asociadas (CIBERDEM), Madrid, Spain., Santacruz E; Department of Endocrinology and Nutrition, Hospital Universitario Ramón y Cajal, Madrid, Spain., Jiménez-Mendiguchia L; Department of Clinical Biochemistry, Hospital Universitario Ramon y Cajal, Madrid, Spain., García-Cano A; Department of Clinical Biochemistry, Hospital Universitario Ramon y Cajal, Madrid, Spain., Nattero-Chávez L; Department of Endocrinology and Nutrition, Hospital Universitario Ramón y Cajal, Madrid, Spain., Escobar-Morreale HF; Department of Endocrinology and Nutrition, Hospital Universitario Ramón y Cajal, Madrid, Spain.; Diabetes, Obesity and Human Reproduction Research Group, Hospital Universitario Ramón y Cajal & Universidad de Alcalá, Instituto Ramón y Cajal de Investigación Sanitaria (IRYCIS), Centro de Investigación Biomédica en Red Diabetes y Enfermedades Metabólicas Asociadas (CIBERDEM), Madrid, Spain., Luque-Ramírez M; Department of Endocrinology and Nutrition, Hospital Universitario Ramón y Cajal, Madrid, Spain.; Diabetes, Obesity and Human Reproduction Research Group, Hospital Universitario Ramón y Cajal & Universidad de Alcalá, Instituto Ramón y Cajal de Investigación Sanitaria (IRYCIS), Centro de Investigación Biomédica en Red Diabetes y Enfermedades Metabólicas Asociadas (CIBERDEM), Madrid, Spain.
Jazyk:	angličtina
Zdroj:	BMJ open [BMJ Open] 2018 May 05; Vol. 8 (5), pp. e019273. Date of Electronic Publication: 2018 May 05.
DOI:	10.1136/bmjopen-2017-019273
Abstrakt:	Objectives: Aiming to validate the use of a single poststimulus sampling protocol for cosyntropin test short standard high-dose test (SST) in our institution, our primary objectives were (1) to determine the concordance between 30 and 60 min serum cortisol (SC) measurements during SST; and (2) to evaluate the diagnostic agreement between both sampling times when using classic or assay-specific and sex-specific SC cut-off values. The secondary objectives included (1) estimating the specificity and positive predictive value of 30 and 60 min sampling times while considering the suspected origin of adrenal insufficiency (AI); and (2) obtaining assay-specific cut-off values for SC after SST in a group of subjects with normal hypothalamic-pituitary-adrenal (HPA) axis. Design and Setting: This is a retrospective chart review study conducted at a Spanish academic hospital from 2011 to 2015. Participants and Interventions: Two groups were evaluated: (1) a main study group including 370 patients in whom SC was measured at 30 and 60 min during SST; and (2) a confirmative group that included 150 women presenting with a normal HPA axis in whom SST was conducted to rule out late-onset congenital adrenal hyperplasia. Diagnostic agreement between both sampling times was assessed by considering both classic (500 nmol/L) and assay-specific SC cut-off concentrations. Results: Diagnostic agreement between both sampling times was greater when applying sex-specific and assay-specific cut-off values instead of the classic cut-off values. For suspected primary AI, 30 min SC determination was enough to establish a diagnosis in over 95% of cases, without missing any necessary treatment. When central AI is suspected, 60 min SC measurement was more specific, establishing a diagnosis in over 97% of cases. Conclusions: Sex-specific and assay-specific SC cut-off values improve the diagnostic accuracy of SST. For primary disease, a subnormal SC response at 30 min is a reliable marker of adrenal dysfunction. On the contrary, when central AI is suspected, 60 min SC measurement improves the diagnostic accuracy of the test. Competing Interests: Competing interests: None declared. (© Article author(s) (or their employer(s) unless otherwise stated in the text of the article) 2018. All rights reserved. No commercial use is permitted unless otherwise expressly granted.)
Databáze:	MEDLINE
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