Use of overnight metyrapone test in suspected secondary adrenal insufficiency: A retrospective single centre‐study
Authors' conclusion
OMT was well tolerated and used in patients with low and moderate pretest probability for SAI. CST can erroneously exclude patients with SAI. Thus, OMT should be considered in selected patients with normal CST.
Study context
- Population
- Adults undergoing outpatient overnight metyrapone test (OMT) for suspected secondary adrenal insufficiency (SAI), 1 April 2018–27 January 2023; median age 48 (IQR 37–58), 71% women
- Participants
- 114 adults
- Exposure
- OMT vs cosyntropin stimulation test
- Outcome
- OMT-based SAI diagnosis and OMT-related adverse events
Methodological detailssingle-centre, outpatient
- Single-centre
- Outpatient
Main finding
As reported in the abstract
Prevalence of OMT-based SAI diagnosis, 11-deoxycortisol cutoff <7 mcg/dL
26
23%
Prevalence of OMT-based SAI diagnosis, 11-deoxycortisol cutoff <10 mcg/dL
47
46%
Cosyntropin stimulation test (CST) specificity vs OMT-based SAI diagnosis (cutoff 10 mcg/dL)
100%
CST sensitivity vs OMT-based SAI diagnosis (cutoff 10 mcg/dL)
52%
Observational data: associations, not effects.
Further findings
Pretest probability for SAI
- Low
- 52 (46%)
- Moderate
- 48 (42%)
- High
- 14 (12%)
Cutoff used to diagnose SAI
- Post-OMT 11-deoxycortisol cutoff of 10 mcg/dL was used most to diagnose SAI
Safety
- Patients with adverse events, mild except one hospitalization
- 7 (6.1%)
- No baseline or OMT-related factors associated with adverse events
Original publication
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