BACKGROUND: The short synacthen test (SST) is the gold standard investigation for the evaluation of adrenal insufficiency and is also frequently used for the evaluation of the hypothalamic-pituitary-adrenal (HPA) axis. The 0900-h serum cortisol concentration has also been evaluated as an indication of cortisol reserve, and a result > 450 nmol/L is highly suggestive of a normal serum cortisol response to the insulin tolerance test, while no patient with a 0900-h serum cortisol < 100 nmol/L had a sufficient response. The aim of this study was to determine if the number of inappropriate SSTs could be reduced if a 0900-h serum total cortisol was done prior to the dynamic function test. METHOD: Two hundred and ten SSTs were performed at 0900 h and the response at 30 min evaluated. RESULTS: Of the 210 SST, 151 (71%) demonstrated a maximum response at 30 min of serum cortisol > 550 nmol/L. All the patients with a 0900-h serum cortisol > 500 nmol/L had an adequate response ( > 550 nmol/L), while no patient with a 0900-h serum cortisol of < 100 nmol/L had an adequate SST response. Twenty one per cent of patients were shown to have had an unnecessary invasive procedure. CONCLUSION: We conclude that the SST is of little added value in patients with a 0900-h serum cortisol of less than 100 nmol/L or more than 500 nmol/L and it should be included in the appropriate protocols for endocrine investigation.
BACKGROUND: The short synacthen test (SST) is the gold standard investigation for the evaluation of adrenal insufficiency and is also frequently used for the evaluation of the hypothalamic-pituitary-adrenal (HPA) axis. The 0900-h serum cortisol concentration has also been evaluated as an indication of cortisol reserve, and a result > 450 nmol/L is highly suggestive of a normal serum cortisol response to the insulin tolerance test, while no patient with a 0900-h serum cortisol < 100 nmol/L had a sufficient response. The aim of this study was to determine if the number of inappropriate SSTs could be reduced if a 0900-h serum total cortisol was done prior to the dynamic function test. METHOD: Two hundred and ten SSTs were performed at 0900 h and the response at 30 min evaluated. RESULTS: Of the 210 SST, 151 (71%) demonstrated a maximum response at 30 min of serum cortisol > 550 nmol/L. All the patients with a 0900-h serum cortisol > 500 nmol/L had an adequate response ( > 550 nmol/L), while no patient with a 0900-h serum cortisol of < 100 nmol/L had an adequate SST response. Twenty one per cent of patients were shown to have had an unnecessary invasive procedure. CONCLUSION: We conclude that the SST is of little added value in patients with a 0900-h serum cortisol of less than 100 nmol/L or more than 500 nmol/L and it should be included in the appropriate protocols for endocrine investigation.
Authors: Laurie S Conklin; Jesse M Damsker; Eric P Hoffman; William J Jusko; Panteleimon D Mavroudis; Benjamin D Schwartz; Laurel J Mengle-Gaw; Edward C Smith; Jean K Mah; Michela Guglieri; Yoram Nevo; Nancy Kuntz; Craig M McDonald; Mar Tulinius; Monique M Ryan; Richard Webster; Diana Castro; Richard S Finkel; Andrea L Smith; Lauren P Morgenroth; Adrienne Arrieta; Maya Shimony; Mark Jaros; Phil Shale; John M McCall; Yetrib Hathout; Kanneboyina Nagaraju; John van den Anker; Leanne M Ward; Alexandra Ahmet; Michaelyn R Cornish; Paula R Clemens Journal: Pharmacol Res Date: 2018-09-13 Impact factor: 7.658
Authors: Stefan R Bornstein; Bruno Allolio; Wiebke Arlt; Andreas Barthel; Andrew Don-Wauchope; Gary D Hammer; Eystein S Husebye; Deborah P Merke; M Hassan Murad; Constantine A Stratakis; David J Torpy Journal: J Clin Endocrinol Metab Date: 2016-01-13 Impact factor: 5.958