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Baseline and peak cortisol response to the low dose short Synacthen test relates to indication for testing, age and sex

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Baseline and peak cortisol response to the low dose short Synacthen test relates to indication for testing, age and sex. / Park, Julie; Titman, Andrew; Lancaster, Gillian et al.

In: Journal of the Endocrine Society, Vol. 6, No. 6, bvac043, 30.06.2022.

Research output: Contribution to Journal/MagazineJournal articlepeer-review

Harvard

Park, J, Titman, A, Lancaster, G, Selvarajah, B, Collingwood, C, Powell, D, Das, U, Dharmaraj, P, Didi, M, Senniappan, S & Blair, J 2022, 'Baseline and peak cortisol response to the low dose short Synacthen test relates to indication for testing, age and sex', Journal of the Endocrine Society, vol. 6, no. 6, bvac043. https://doi.org/10.1210/jendso/bvac043

APA

Park, J., Titman, A., Lancaster, G., Selvarajah, B., Collingwood, C., Powell, D., Das, U., Dharmaraj, P., Didi, M., Senniappan, S., & Blair, J. (2022). Baseline and peak cortisol response to the low dose short Synacthen test relates to indication for testing, age and sex. Journal of the Endocrine Society, 6(6), [ bvac043]. https://doi.org/10.1210/jendso/bvac043

Vancouver

Park J, Titman A, Lancaster G, Selvarajah B, Collingwood C, Powell D et al. Baseline and peak cortisol response to the low dose short Synacthen test relates to indication for testing, age and sex. Journal of the Endocrine Society. 2022 Jun 30;6(6): bvac043. Epub 2022 Mar 19. doi: 10.1210/jendso/bvac043

Author

Park, Julie ; Titman, Andrew ; Lancaster, Gillian et al. / Baseline and peak cortisol response to the low dose short Synacthen test relates to indication for testing, age and sex. In: Journal of the Endocrine Society. 2022 ; Vol. 6, No. 6.

Bibtex

@article{02f6ceac25584cd2945b365a0ee273c3,
title = "Baseline and peak cortisol response to the low dose short Synacthen test relates to indication for testing, age and sex",
abstract = "Objective To review the outcomes of a simplified low dose Synacthen test (LDSST) performed in a tertiary endocrine service over seven years, and to examine for relationships between cortisol measurements and indication for testing, age and sex. Design Retrospective, observational study of LDSST performed in 2008 – 2014 (N=335) and 2016-2020 (N=160). Methods LDSST were performed by endocrine nurses. Synacthen 500ng/1.73m 2 administered as IV bolus, sampling at 0, 15, 25 and 35 minutes. Results Mean (± 1SD) baseline cortisol was 221 ± 120 nmol/L, peak 510 ± 166nmol/L and increment 210 ± 116 nmol/L. 336 (70%) of patients had a normal response (baseline cortisol >100nmol/L, peak >450nmol/L), 78 (16%) a suboptimal response (peak cortisol 350-450nmol/L) and were prescribed hydrocortisone to during periods of stress only, 67 (14%) an abnormal response (baseline <100nmol/L or peak <350nmol/L) and were prescribed daily hydrocortisone. Basal, peak and incremental increases in cortisol were higher in females (p=0.03, p<0.001, p=0.03 respectively). Abnormal results occurred most frequently in patients treated previously with pharmacological doses of glucocorticoids or structural brain abnormalities (p<0.0001). Discussion There are concerns that the specificity of the LDSST is poor. The low prevalence and strong association of abnormal results with indication for testing, suggests that over diagnosis occurred infrequently in this clinical setting.",
keywords = "adrenal, Synacthen, hypothalamic-pituitary-adrenal axis testing, HPA, low-dose short Synacthen test, hydrocortisone",
author = "Julie Park and Andrew Titman and Gillian Lancaster and Bhavana Selvarajah and Catherine Collingwood and Darren Powell and Urmi Das and Poonam Dharmaraj and Mohammed Didi and Senthil Senniappan and Joanne Blair",
year = "2022",
month = jun,
day = "30",
doi = "10.1210/jendso/bvac043",
language = "English",
volume = "6",
journal = "Journal of the Endocrine Society",
issn = "2472-1972",
publisher = "The Endocrine Society",
number = "6",

}

RIS

TY - JOUR

T1 - Baseline and peak cortisol response to the low dose short Synacthen test relates to indication for testing, age and sex

AU - Park, Julie

AU - Titman, Andrew

AU - Lancaster, Gillian

AU - Selvarajah, Bhavana

AU - Collingwood, Catherine

AU - Powell, Darren

AU - Das, Urmi

AU - Dharmaraj, Poonam

AU - Didi, Mohammed

AU - Senniappan, Senthil

AU - Blair, Joanne

PY - 2022/6/30

Y1 - 2022/6/30

N2 - Objective To review the outcomes of a simplified low dose Synacthen test (LDSST) performed in a tertiary endocrine service over seven years, and to examine for relationships between cortisol measurements and indication for testing, age and sex. Design Retrospective, observational study of LDSST performed in 2008 – 2014 (N=335) and 2016-2020 (N=160). Methods LDSST were performed by endocrine nurses. Synacthen 500ng/1.73m 2 administered as IV bolus, sampling at 0, 15, 25 and 35 minutes. Results Mean (± 1SD) baseline cortisol was 221 ± 120 nmol/L, peak 510 ± 166nmol/L and increment 210 ± 116 nmol/L. 336 (70%) of patients had a normal response (baseline cortisol >100nmol/L, peak >450nmol/L), 78 (16%) a suboptimal response (peak cortisol 350-450nmol/L) and were prescribed hydrocortisone to during periods of stress only, 67 (14%) an abnormal response (baseline <100nmol/L or peak <350nmol/L) and were prescribed daily hydrocortisone. Basal, peak and incremental increases in cortisol were higher in females (p=0.03, p<0.001, p=0.03 respectively). Abnormal results occurred most frequently in patients treated previously with pharmacological doses of glucocorticoids or structural brain abnormalities (p<0.0001). Discussion There are concerns that the specificity of the LDSST is poor. The low prevalence and strong association of abnormal results with indication for testing, suggests that over diagnosis occurred infrequently in this clinical setting.

AB - Objective To review the outcomes of a simplified low dose Synacthen test (LDSST) performed in a tertiary endocrine service over seven years, and to examine for relationships between cortisol measurements and indication for testing, age and sex. Design Retrospective, observational study of LDSST performed in 2008 – 2014 (N=335) and 2016-2020 (N=160). Methods LDSST were performed by endocrine nurses. Synacthen 500ng/1.73m 2 administered as IV bolus, sampling at 0, 15, 25 and 35 minutes. Results Mean (± 1SD) baseline cortisol was 221 ± 120 nmol/L, peak 510 ± 166nmol/L and increment 210 ± 116 nmol/L. 336 (70%) of patients had a normal response (baseline cortisol >100nmol/L, peak >450nmol/L), 78 (16%) a suboptimal response (peak cortisol 350-450nmol/L) and were prescribed hydrocortisone to during periods of stress only, 67 (14%) an abnormal response (baseline <100nmol/L or peak <350nmol/L) and were prescribed daily hydrocortisone. Basal, peak and incremental increases in cortisol were higher in females (p=0.03, p<0.001, p=0.03 respectively). Abnormal results occurred most frequently in patients treated previously with pharmacological doses of glucocorticoids or structural brain abnormalities (p<0.0001). Discussion There are concerns that the specificity of the LDSST is poor. The low prevalence and strong association of abnormal results with indication for testing, suggests that over diagnosis occurred infrequently in this clinical setting.

KW - adrenal

KW - Synacthen

KW - hypothalamic-pituitary-adrenal axis testing

KW - HPA

KW - low-dose short Synacthen test

KW - hydrocortisone

U2 - 10.1210/jendso/bvac043

DO - 10.1210/jendso/bvac043

M3 - Journal article

VL - 6

JO - Journal of the Endocrine Society

JF - Journal of the Endocrine Society

SN - 2472-1972

IS - 6

M1 - bvac043

ER -