Diagnostic performance of morning serum cortisol for glucocorticoid weaning in children and adults
Authors' conclusion
Morning serum cortisol can predict the SST outcome in children and adults weaning from glucocorticoids. An EMC > 290 nmol/L in adults predicts a patient can stop glucocorticoid therapy and will recover adrenal function.
Study context
- Population
- Pediatric and adult patients on long-term glucocorticoids with suspected glucocorticoid-induced adrenal insufficiency (GIAI) undergoing an short synacthen test (SST)151 and 372 SSTs
- Exposure
- EMC to predict SST outcome in children and adults
- Outcome
- EMC cut-offs with 95% and 99% sensitivity and specificity (modern immunoassays), by ROC curve analysis; SST pass = 30-min cortisol ≥430 nmol/L (15.6 µg/dL)
Main finding
As reported in the abstract
EMC prediction of SST pass
| Group | SSTs passed | AUC | Cut-off at 95% sensitivity | Cut-off at 99% sensitivity |
|---|---|---|---|---|
| Pediatric | 32% | 0.79 (95% CI, 0.71, 0.87) | 278 (10.1 µg/dL) | 316 (11.5 µg/dL) |
| Adult | 37% | 0.88 (95% CI, 0.84, 0.91) | 290 nmol/L (10.5 µg/dL) | 349 nmol/L (12.7 µg/dL) |
SSTs passed
Pediatric32%
Adult37%
AUC
Pediatric0.79 (95% CI, 0.71, 0.87)
Adult0.88 (95% CI, 0.84, 0.91)
Cut-off at 95% sensitivity
Pediatric278 (10.1 µg/dL)
Adult290 nmol/L (10.5 µg/dL)
Cut-off at 99% sensitivity
Pediatric316 (11.5 µg/dL)
Adult349 nmol/L (12.7 µg/dL)
Observational data: associations, not effects.
Further findings
- Adults with EMC between 290 and 349 nmol/L (10.5-12.7 µg/dL) weaned off without adverse events — Adult
- 48/51 events
Safety
Adverse events after weaning, adults with EMC 290–349 nmol/L
- Weaned off without adverse events
- 48/51 patients
Original publication
Diagnostic performance of morning serum cortisol for glucocorticoid weaning in children and adults. Eur J Endocrinol. Published 15 October 2025. doi:10.
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