“A morning cortisol is the most effective clinical predictor of short synacthen test outcome”: A tertiary care centre experience
Authors' conclusion
Adverse effects to synacthen are rare. Pretest morning cortisol is a reliable predictor for SST outcome and is a helpful tool to rationalise use of the SST. Predictive morning-cortisol thresholds vary according to the aetiology of AI.
Study context
- Population
- All patients referred for short-synacthen test (SST) in Oxford, 2017–2021, for suspected adrenal insufficiency (AI); males 38%, age 52 [39–66] yearsSSTs performed
- Participants
- 1,480 patients
- Exposure
- Group 1 vs Group 2 vs Group 3
- Group 1n = 505
- Group 2n = 838
- Group 3n = 137
- Outcome
- Pretest predictors of SST outcome ("SST pass") and adverse event profile of the SST
Methodological detailssingle-centre, tertiary care centre
- Single-centre
- Tertiary care centre
Main finding
As reported in the abstract
Predictors of SST pass; pretest morning cortisol threshold predicting SST pass with 100% specificity
| Group | Value | ROC AUC | 95% CI | P | Specificity |
|---|---|---|---|---|---|
| Group 1 | ≥300 nmol/L | 0.763 | 0.675 to 0.850 | p < 0.001 | 100% |
| Group 2 | ≥340 nmol/L | 0.688 | 0.615 to 0.761 | p < 0.001 | 100% |
| Group 3 | ≥376 nmol/L | 0.783 | 0.708 to 0.859 | p < 0.001 | 100% |
Value
Group 1≥300 nmol/L
Group 2≥340 nmol/L
Group 3≥376 nmol/L
ROC AUC
Group 10.763
Group 20.688
Group 30.783
95% CI
Group 10.675 to 0.850
Group 20.615 to 0.761
Group 30.708 to 0.859
P
Group 1p < 0.001
Group 2p < 0.001
Group 3p < 0.001
Specificity
Group 1100%
Group 2100%
Group 3100%
- Whole cohort: B for morning cortisol
- B = 0.015, p < 0.001
- Group 1: B for morning cortisol
- B = 0.018, p < .001
- Group 2: B for morning cortisol
- B = 0.010, p < 0.012
- Group 3: B for morning cortisol
- B = 0.018, p = <.001
- Whole cohort: morning cortisol threshold ≥343 nmol/l predicting SST pass with 100% specificity; ROC AUC
- 0.725, p < 0.001 (95% CI 0.675-0.775)
Observational data: associations, not effects.
Safety
Adverse effects of SST
- Tests with adverse effects recorded
- 1.8%
- Anaphylaxis
- 1 episode
Original publication
“A morning cortisol is the most effective clinical predictor of short synacthen test outcome”: A tertiary care centre experience. Clin Endocrinol (Oxf). Published 8 June 2023. doi:10.
Composed by AI from the published abstract and checked against it. How Briefs are made →