Challenges in Diagnosing Central Adrenal Insufficiency in Children: Cortisol‐Stimulating Tests are Safe and Often Required
Authors' conclusion
Fbasal did not present good diagnostic accuracy. However, Fbasal < 96.6 nmol/L predicted lower Fpeak. Therefore, many patients require CST to confirm or exclude CAI. ITT and GST are safe for young patients when performed in experienced centers in a controlled environment.
Study context
- Population
- Children submitted to ITT or glucagon-stimulation test (GST) for hypothalamic-pituitary-adrenal (HPA) axis assessment, tertiary centre; 60.1% males, median age 10.1 years (0.1–17.1)
- Participants
- 904 children
- Exposure
- Basal and peak cortisol on ITT or GST for diagnosing central adrenal insufficiency
- Outcome
- Diagnostic accuracy (sensitivity, specificity, LR) and safety of CST for central adrenal insufficiency
Methodological detailssingle tertiary centre, diagnostic accuracy, 15 years
- Single tertiary centre
- Diagnostic accuracy
- 15 years
Main finding
As reported in the abstract
Diagnostic accuracy for central adrenal insufficiency
| Group | Cutoff | Specificity | Likelihood ratios (LR)+ | Sensitivity |
|---|---|---|---|---|
| Fbasal | 96.6 | 99% | 7.6 | 5.3% |
| Fpeak (GST) | 303.5 | 2.8 | 17% |
Cutoff
Fbasal96.6
Fpeak (GST)303.5
Specificity
Fbasal99%
Fpeak (GST)— not stated in the abstract
Likelihood ratios (LR)+
Fbasal7.6
Fpeak (GST)2.8
Sensitivity
Fbasal5.3%
Fpeak (GST)17%
- Central adrenal insufficiency confirmed
- 79 (8.7%)
- Fbasal classified patients as indeterminate
- 58%
Observational data: associations, not effects.
Further findings
Factors associated with cortisol
- Concomitant central hypothyroidism and Fbasal < 154.5 associated with lower Fpeak
- Pituitary stalk interruption associated with lower Fbasal and Fpeak
Safety
Adverse events of CST
- Mild hypoglycemia (ITT)
- 46%
- Nausea and vomiting (GST)
- 17.5%
- Serious adverse events
- 0
Parts of this Brief are withheld: the automatic checks could not confirm them against the abstract.
Original publication
Challenges in Diagnosing Central Adrenal Insufficiency in Children: Cortisol‐Stimulating Tests are Safe and Often Required. Clin Endocrinol (Oxf). Published 17 May 2026. doi:10.
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