A Pragmatic Approach to Monitor for Adrenal Axis Recovery After a Failed Short Synacthen Test
Authors' conclusion
An early morning cortisol ≤126 nmol/L is common in those followed for adrenal axis recovery and is an accurate indicator of non-recovery. Baseline cortisol measurements are therefore a simple way of screening for adrenal axis recovery. Those with a cortisol of >126 nmol/L should go on to have an SST. Using this approach could considerably reduce the need for follow up SSTs in this patient cohort.
Study context
- Population
- Patients undergoing short Synacthen test (SST) over 10 years (1 February 2013–30 January 2023) with baseline cortisol taken before 9:30 am; follow-up SSTs in those who failed a first SST
- Participants
- 952 patients1,570 SSTs
- Outcome
- Morning cortisol threshold confirming non-recovery of the adrenal axis (<5% chance of passing an SST)
Methodological detailssingle-centre, quantile regression model, Cortisol measured by Abbott Architect method; 30- and 60-minute cortisol measured
- Single-centre
- Quantile regression model
- Cortisol measured by Abbott Architect method; 30- and 60-minute cortisol measured
Main finding
As reported in the abstract
Early morning cortisol threshold for failing an SST
Follow-up SSTs with baseline cortisol below threshold
69/115 (Sixty percent)
Follow-up SSTs below threshold that passed an SST
0
Observational data: associations, not effects.
Original publication
A Pragmatic Approach to Monitor for Adrenal Axis Recovery After a Failed Short Synacthen Test. Endocr Pract. Published 5 March 2025. doi:10.
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