The Use of Baseline Cortisol Level in Predicting the Outcome of 1 μg Synacthen Tests in an Outpatient Endocrinology Unit

Overview

Journal Heliyon

Specialty Social Sciences

Date 2022 Jun 13

PMID 35694426

Authors

Najoua Lassoued

Baha Zantour

Wafa Alaya

Mohamed Hbib Sfar

Affiliations

Soon will be listed here.

Abstract

Introduction: The clinical requirements and the indication of the Synacthen test are increasing. The objective of our study is to determine a baseline cortisol level that reliably predicts the response to Synacthen test in a low-risk group of patients.

Materials And Methods: We performed a cross-sectional analysis of all Synacthen tests conducted between January 2017 and June 2018. The diagnostic accuracy of basal cortisol levels as a predictor of an adequate response to Synacthen test was evaluated by ROC curve analysis.

Results: One hundred and fifty-three patients were included. A baseline cortisol level <40 ng/mL had a sensitivity of 100% but a specificity of 5.8% for the failure of the Synacthen test, while a baseline cortisol level> 147.5 ng/mL showed a specificity of 100% but a sensitivity of 1.2% for an adequate response to the Synacthen test. According to the ROC curve, the optimal baseline cortisol level for predicting an adequate response to the Synacthen test was 85 ng/mL with an AUC of 0.808 (95% CI [0.738-0.877]).

Conclusion: We propose a basal cortisol level assay as a first step in the evaluation of patients with suspected adrenal insufficiency.

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