Adrenal Insufficiency During Treatment With Immune‐Checkpoint Inhibitors: How to Simplify the Diagnostic Pathway?
Authors' conclusion
Morning SC is a reliable tool for the screening of ICI-related AI; the need for dynamic stimulation would be reduced by the application of assay-specific cut-offs. Salivary hormone analysis of cortisol and cortisone upon awakening may represent a viable alternative in selected cases.
Study context
- Population
- ICI-treated cancer patients with morning serum cortisol (SC) within the grey zone (83–414 nmol/L)
- Participants
- 30 patients
- Outcome
- Refined morning SC cut-offs to minimize the diagnostic grey zone, reducing need for adrenocorticotropic hormone (ACTH) stimulation (low-dose ACTH test; peak stimulated SC thresholds 500 nmol/L and assay-specific 414 nmol/L)
Main finding
As reported in the abstract
- Correlation between morning and peak stimulated SC
- r = 0.72, p < 0.001
- Peak stimulated SC ≤ 500 nmol/L
- 36.7%
- Peak stimulated SC ≤ 414 nmol/L
- 20%
- Optimal morning SC thresholds (ROC) for adrenal insufficiency (AI) exclusion and prediction, peak SC ≤ 500 nmol/L criterion
- > 196 nmol/L and ≤ 397 nmol/L
- Optimal morning SC thresholds (ROC) for AI exclusion and prediction, peak SC ≤ 414 nmol/L criterion
- > 163 nmol/L and ≤ 251 nmol/L
Observational data: associations, not effects.
Further findings
Salivary cortisol and cortisone upon awakening vs peak stimulated SC
- Salivary cortisol correlation with peak stimulated SC
- r = 0.49, p < 0.01
- Salivary cortisone correlation with peak stimulated SC
- r = 0.56, p < 0.01
Original publication
Adrenal Insufficiency During Treatment With Immune‐Checkpoint Inhibitors: How to Simplify the Diagnostic Pathway? Clin Endocrinol (Oxf). Published 28 August 2025. doi:10.
Composed by AI from the published abstract and checked against it. How Briefs are made →