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Can a random serum cortisol reduce the need for short synacthen tests in acute medical admissions?

Kadiyala, R., Kamath, Chandan, Baglioni, Piero, Geen, J. and Okosieme, Onyebuchi E. 2010. Can a random serum cortisol reduce the need for short synacthen tests in acute medical admissions? Annals of Clinical Biochemistry 47 (4) , pp. 378-380. 10.1258/acb.2010.010008

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Abstract

Background Short synacthen tests (SSTs) are frequently performed in medical inpatients with suspected adrenocortical insufficiency. The utility of a random or baseline serum cortisol in this setting is unclear. We determined random cortisol thresholds that safely preclude SSTs in acute medical admissions. Methods We analysed SSTs in acute non-critically ill general medical patients (n = 166, median age 66, range 15–94 y; men 48%, women 52%). The SST was defined according to the 30-min cortisol as ‘pass’ (>550 nmol/L) or ‘fail’ (≤550 nmol/L). Receiver operating characteristics (ROC) curves were generated to determine the predictive value of the basal cortisol for a failed SST. Results Of 166 SSTs, a pass was seen in 127 (76.5%) tests, while 39 (23.5%) tests failed the SST. ROC curves showed that no single cut-off point of the baseline cortisol was adequately both sensitive and specific for failing the SST despite a good overall predictive value (area under curve 0.94; 95% confidence interval 0.89–0.98). A basal cortisol <420 nmol/L had 100% sensitivity and 54% specificity for failing the SST, while a basal cortisol <142 nmol/L had 100% specificity and 35% sensitivity. Restricting the SST to patients with a basal cortisol <420 nmol/L would have prevented 44% of SSTs while correctly identifying all patients who failed the SST. Conclusion A baseline serum cortisol may prevent unnecessary SSTs in medical inpatients with suspected adrenocortical insufficiency. However, SSTs are still indicated in patients with random cortisol <420 nmol/L, or where the suspicion of adrenal insufficiency is compelling.

Item Type: Article
Date Type: Publication
Status: Published
Schools: Medicine
Postgraduate Medical and Dental Education
Subjects: R Medicine > R Medicine (General)
Publisher: Sage
ISSN: 0004-5632
Last Modified: 04 Jun 2017 03:55
URI: http://orca-mwe.cf.ac.uk/id/eprint/29165

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