Comparing the utility of 30- and 60-minute cortisol levels after the standard short synacthen test to determine adrenal insufficiency

Autor: Nouf Alzuhayri, Lama Amer, Eman Alrajhi, Muhammad Sohaib Khan, Hadeel Aljamei, Anhar Alnassar, Dina Mahmoud Ahmad Aljayar, Mohammed Abufarhaneh, Reem Alahmed, Muhammad Imran Butt, Edward De Vol, Muhammad Riazuddin, Fayha Farraj Abothenain
Rok vydání: 2020
Předmět:
Adult
Male
endocrine system
medicine.medical_specialty
Time Factors
Hydrocortisone
Cross-sectional study
adrenocorticotropic hormone
Observational Study
Adrenocorticotropic hormone
Logistic regression
Gastroenterology
03 medical and health sciences
0302 clinical medicine
Internal medicine
Hypoadrenalism
Adrenal insufficiency
Humans
Medicine
Short synacthen test
False Positive Reactions
030212 general & internal medicine
Cortisol level
addison disease
Aged
Retrospective Studies
pituitary-adrenal system
business.industry
Reproducibility of Results
Retrospective cohort study
General Medicine
Middle Aged
medicine.disease
Cross-Sectional Studies
cosyntropin
030220 oncology & carcinogenesis
hypothalamicpituitary-adrenal axis
Female
adrenal insufficiency
business
hormones
hormone substitutes
and hormone antagonists
Research Article
Zdroj: Medicine
ISSN: 1536-5964
0025-7974
DOI: 10.1097/md.0000000000022621
Popis: Short Synacthen test (SST) involves measuring the baseline, 30-, and 60-minute serum cortisol levels, after injecting 250 μg of synthetic adrenocorticotropic hormone or Synacthen (ACTH). This study aimed to review the current clinical practice of performing SST to establish a standardized test protocol and to additionally test the hypothesis regarding performing the 60-minute cortisol test alone and the dependence of overall SST result on baseline cortisol level. Patients >14 years who underwent SST from January 2010 to December 2017 were included. Pearson's chi-square cross-tabulation was used to identify individuals with inconsistent 30- and 60-minute serum cortisol test results. Logistic regression analysis was performed to predict normal responses based on the baseline cortisol value. Of the 965 patients identified from pharmacy, medical, and laboratory records, 849 were included. Mean baseline, 30-, and 60-minute cortisol levels after ACTH injection were 394 ± 286.58, 722 ± 327.11, and 827 ± 369.30 nmol/L, respectively. Overall, 715 (84%) and 134 (16%) patients had normal and abnormal responses, respectively. Primary and secondary adrenal insufficiency was diagnosed in 10% and 35%, respectively, while ACTH levels were not measured in 55% of the patients. Overall, 9.49% (n = 72) of the patients had a suboptimal response at 30 minutes, but reached the threshold value of 550 nmol/L at 60 minutes. This particular subgroup's mean change (240 nmol/L) in cortisol level from baseline to 30-minute was higher than that observed in patients with abnormal response at both time-points (mean change, 152 nmol/L). No patient with 30-minute optimal responses had 60-minute suboptimal responses. The baseline serum cortisol threshold of ≥226 nmol/L had 80% sensitivity, 71% specificity, and 93% positive predictive value for detecting a normal SST (P-value
Databáze: OpenAIRE
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