Redefining ITT cortisol thresholds on Abbott platforms to prevent misdiagnosis of adrenal insufficiency
Authors' conclusion
This data supports lowering the Abbott analyser ITT peak cortisol threshold to 416 nmol/L. Use of this improved cut-off avoids unnecessary glucocorticoid replacement therapy in 104 (34.7%) of individuals in this study. All patients remained well with at least 1 year longitudinal follow up of glucocorticoid replacement.
Study context
- Population
- Patients with suspected adrenal insufficiency (AI) undergoing ITT, cortisol on Abbott Architect and Alinity platforms, tertiary centre, August 2010 to January 2022; AI status by specialist panel review of records
- Participants
- 300 ITT cortisol responses
- Comparison
- ITT peak cortisol cut-off 416 nmol/L vs current 500 nmol/L on Abbott platforms
- Outcome
- Diagnostic accuracy (sensitivity, specificity) of ITT peak cortisol cut-offs for AI
Methodological detailssingle tertiary centre, ROC analysis
- Single tertiary centre
- ROC analysis
Performance
As reported in the abstract
Diagnosis of AI
| Strategy | AUC | Sensitivity | Specificity |
|---|---|---|---|
| 500 nmol/L | 0.979 | 100.0% | 43.6% |
| 416 nmol/L | — not stated in the abstract | 100.0% | 86.7% |
AUC
500 nmol/L0.979
416 nmol/L— not stated in the abstract
Sensitivity
500 nmol/L100.0%
416 nmol/L100.0%
Specificity
500 nmol/L43.6%
416 nmol/L86.7%
— not stated in the abstract
Further findings
Unnecessary glucocorticoid replacement avoided with 416 nmol/L cut-off
- Individuals avoiding unnecessary replacement
- 104 (34.7%)
Safety
Clinical outcome · ≥1 year follow-up
- All patients remained well with at least 1 year longitudinal follow up of glucocorticoid replacement
Original publication
Redefining ITT cortisol thresholds on Abbott platforms to prevent misdiagnosis of adrenal insufficiency. Clin Endocrinol (Oxf). Published 27 May 2024. doi:10.
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