Pre-test Cortisol Levels in Predicting Short Synacthen Test Outcome: A Retrospective Analysis

Overview

Journal Clin Med Insights Endocrinol Diabetes

Publisher Sage Publications

Specialty Endocrinology

Date 2022 May 13

PMID 35558546

Authors

Ravikumar Ravindran

Joanne L Carter

Asit Kumar

Florin Capatana

Ishrat N Khan

Mohamed A Adlan

Lakdasa D Premawardhana

Affiliations

Soon will be listed here.

Abstract

Objective: Short Synacthen tests (SSTs) are expensive, dependent on Synacthen availability, and need supervision. To reduce SST testing, we examined the utility of pre-test cortisol (Cort0) and related parameters in predicting outcome.

Design And Measurements: We retrospectively examined the following in all SSTs; (i) Cort0 (ii) indications (iii) and time and place of testing. Receiver operated characteristic (ROC) curves were devised for Cort0 to obtain the best cut-off for outcome prediction in those who had SSTs between 8 and 10 am (Group 1) and at other times (Group 2).

Results: Of 506 SSTs, 13 were unsuitable for analysis. 111/493 SSTs (22.5%) were abnormal. (1) ROC curves predicted - (a) SST failure with 100% specificity when Cort0 was ⩽124 nmol/L (Group 1), or ⩽47 (Group 2); (b) a normal SST with 100% sensitivity when Cort0 ⩾314 nmol/L (Group 1) and ⩾323 nmol/L (Group 2). (2) There was significant correlation between Cort0 and 30-minute cortisol ( = 0.65-0.78, < .001). (3) Median Cort0 was lower in those who failed SSTs compared to those who passed (147 vs 298 nmol/L respectively, < .001). (4) SST failure was commoner in Group 1 vs 2 ( = .001). (5) There was no difference in outcome between out-patient and inpatient SSTs. (6) SST failure was most common for 'steroid related' indications (39.6%, < .001).

Conclusions: This study indicates that (1) Cort0 ⩾ 323 (Group1) and ⩾314 nmol/L (Group 2) predicted a normal SST with 100% sensitivity; (2) Using these cut offs 141/493 (28.6%) tests may have been avoided; (3) supporting evidence should be considered in those with a lower pre-test predictability of failure.

Citing Articles

European Society of Endocrinology and Endocrine Society Joint Clinical Guideline: Diagnosis and Therapy of Glucocorticoid-induced Adrenal Insufficiency.

Beuschlein F, Else T, Bancos I, Hahner S, Hamidi O, van Hulsteijn L J Clin Endocrinol Metab. 2024; 109(7):1657-1683.

PMID: 38724043 PMC: 11180513. DOI: 10.1210/clinem/dgae250.

ACTH Stimulation Test for the Diagnosis of Secondary Adrenal Insufficiency: Light and Shadow.

Birtolo M, Antonini S, Saladino A, Zampetti B, Lavezzi E, Chiodini I Biomedicines. 2023; 11(3).

PMID: 36979883 PMC: 10045406. DOI: 10.3390/biomedicines11030904.

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