Optimal Low-Dose Synacthen Stimulation Test Sampling Time for Diagnosis of Adrenal Insufficiency Using Monoclonal Antibody Immunoassay
Authors' conclusion
In LDSST, measurement of plasma cortisol at 40th and 60th minutes reduces the risk of false positivity. Single sampling at 40th minute yielded fewer false negatives than sampling at 30th or 60th minute.
Study context
- Population
- Children with clinical suspicion of adrenal insufficiency (AI) undergoing low-dose synacthen stimulation test (LDSST)61 girls
- Participants
- 132 children
- Comparison
- Cortisol sampling time-points during LDSST using monoclonal antibody (mAb) immunoassay
- Outcome
- Best time-points and sampling approach for cortisol measurement using mAb immunoassay during LDSST; AI defined by peak cortisol <18 μg/dL (500 nmol/L)
Methodological detailsprospective, Morning basal cortisol measured in 119 patients by both mAb immunoassay and liquid chromatography-mass spectrometry
- Prospective
- Morning basal cortisol measured in 119 patients by both mAb immunoassay and liquid chromatography-mass spectrometry
Performance
As reported in the abstract
Prediction of LDSST outcome by sampling time-point
- Single measurement: 40th min showed the highest specificity
- 89.1%
- Two time-point measurements: 40th and 60th min significantly more sensitive than other possibilities
- p < 0.001
Further findings
AI excluded
- AI excluded
- 80.3% (n = 106)
Morning basal cortisol
- Morning basal cortisol below 6.5 μg/dL predictive of a failed LDSST
Original publication
Optimal Low-Dose Synacthen Stimulation Test Sampling Time for Diagnosis of Adrenal Insufficiency Using Monoclonal Antibody Immunoassay. Horm Res Paediatr. Published 3 March 2025. doi:10.
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