How reliable is the short synacthen test after pituitary surgery?

2006 ◽  
Vol 2 (7) ◽  
pp. 368-369
Author(s):  
Paul L Padfield
Keyword(s):  
Pituitary Surgery ◽  
Synacthen Test ◽  
Short Synacthen Test

Adrenocortical insufficiency after pituitary surgery: an audit of the reliability of the conventional short synacthen test

2005 ◽  
Vol 63 (5) ◽  
pp. 499-505 ◽  
Author(s):  
M. Klose ◽  
M. Lange ◽  
M. Kosteljanetz ◽  
L. Poulsgaard ◽  
U. Feldt-Rasmussen
Keyword(s):  
Pituitary Surgery ◽  
Adrenocortical Insufficiency ◽  
Synacthen Test ◽  
Short Synacthen Test

scholarly journals MON-155 Retrospective Cross-Sectional Study to Assess the Utility of 30 vs 60 Minutes Serum Cortisol Value Attained During a Short Synacthen Test (SST)

2020 ◽  
Vol 4 (Supplement_1) ◽  
Author(s):  
Muhammad Imran Butt ◽  
Lama Ghassan Amer ◽  
Hadeel Salah Aljamei ◽  
Muhammad Riazuddin ◽  
Nouf AlZuhairy ◽  
...  
Keyword(s):  
Pituitary Surgery ◽  
Serum Cortisol ◽  
Cross Sectional Study ◽  
P Value ◽  
Normal Response ◽  
Cross Sectional ◽  
Basal Cortisol ◽  
Synacthen Test ◽  
Gland Function ◽  
Short Synacthen Test

Abstract Background SST is done to assess adrenal gland function by measuring basal serum cortisol followed by injecting 250 μg of Synacthen (ACTH) & measuring cortisol at 30 & 60 minutes. Design All patients over 14 years (adulthood age in the region) who had undergone a SST from January 2010 to December 2017 were included. Patients who underwent pituitary surgery in preceding 2 months, on exogenous steroids, opioids & oral contraceptives were excluded. Stimulated cortisol of 550 nmol/L or more achieved at 30, 60 minutes or both was classified as a normal response. Results 965 patients were identified from pharmacy, medical & laboratory records. 116 patients were excluded and 849 were included in the analysis. Mean age was 50.5 ± 20.45 years. Mean weight was 67 ± 21 Kg. 54% patients were female. Mean basal, 30 and 60 minutes cortisol values after ACTH injection were 394 ± 286.58 nmol/L, 722 ± 327.11 nmol/L, 827 ± 369.30 nmol/L respectively. 715 patients (84 %) had a normal response and 134 patients (16 %) had suboptimal response. Primary and secondary adrenal insufficiency was diagnosed in 10% and 35% respectively. No ACTH value was available in 55% of the patients. Suboptimal response was observed at 30 minutes in 9.49% (n=72) of the patients: all crossed 550 nmol/L threshold at 60 minutes. Mean change of cortisol level from baseline to 30 minutes was 240 nmol/L in this particular sub group which was higher than the mean change of 152 nmol/L observed in patients who failed the test overall up to 60 minutes. No patient with optimal response at 30 minutes had suboptimal response at 60 min. Morning basal cortisol threshold of 226 nmol/L or over had 80% sensitivity, 71 % specificity & 93% positive predictive value to detect a normal SST (P-value <.0001). Conclusion 60 minute cortisol correctly identified all normal and abnormal results. Relying only on 30 min value resulted in significant false positive results. Morning basal cortisol over 226 nmol/L should be considered reliable threshold for adequate adrenal function particularly when clinicians have low pretest probability for hypoadrenalism.

scholarly journals What is the value of the 60‐minute cortisol measurement in the short synacthen test (SST)? Evidence for the defence

2021 ◽  
Vol 75 (8) ◽  
Author(s):  
Maria Michaelidou ◽  
Ghasem Yadegarfar ◽  
Lauren Morris ◽  
Samantha Dolan ◽  
Adam Robinson ◽  
...  
Keyword(s):  
Synacthen Test ◽  
Short Synacthen Test

Response to ‘Determining the utility of the 60-min cortisol measurement in the short Synacthen test’

2013 ◽  
Vol 80 (5) ◽  
pp. 766-767
Author(s):  
Carol Evans ◽  
Nadia El-Farhan ◽  
David Ducroq ◽  
Aled Rees
Keyword(s):  
Synacthen Test ◽  
Short Synacthen Test

Do we need 30 min cortisol measurement in the short synacthen test: a retrospective study

2019 ◽  
Vol 96 (1138) ◽  
pp. 467-472
Author(s):  
Rajeev Kumar ◽  
Peter Carr ◽  
Kimberley Moore ◽  
Zeeshan Rajput ◽  
Louise Ward ◽  
...  
Keyword(s):  
Retrospective Study ◽  
Adrenal Insufficiency ◽  
Late Response ◽  
Inadequate Response ◽  
Insufficient Response ◽  
Group A ◽  
Synacthen Test ◽  
Cortisol Levels ◽  
Group B ◽  
Short Synacthen Test

ObjectiveThe short synacthen test (SST) is widely used across the UK to assess adrenal reserve but there remains no consensus on the timing of cortisol sampling to help diagnose adrenal insufficiency. The main objective of our study was to see if both 30 and 60 min sample are required following administration of synacthen to investigate suspected adrenal insufficiency (AI).DesignThis was a single-centre retrospective study of 393 SSTs measuring 0, 30 and 60 min cortisol levels after administration of 250 µg of synacthen.Patients and methodsAll the SSTs for patients suspected of primary or secondary AI between April 2016 and October 2018 were included in this study. The tests were performed as per our hospital protocol. A post-adrenocorticotropic hormone (ACTH) cortisol response of 420 nmol/L at any time point was considered adequate to rule out AI. The data were analysed to ascertain the proportion of patients who achieved this level at 30 and/or 60 min.ResultsA total of 393 SST results were included in this study. Patients were divided into two groups depending on whether (group A) or not (group B) they were on steroids. Overall, a total of 313 (79.6%) subjects achieved cortisol level of ≥420 nmol/L at 30 and 60 min while 19 (4.8%) had late response (ie, insufficient 30 min cortisol levels, rising to ≥420 nmol/L at 60 min). Another 61 subjects (15.5%) showed insufficient response at both 30 and 60 min (ie, failed to achieved level of ≥420 nmol/L). Importantly, there was no patient in either group who had adequate response at 30 min and then failed at 60 min. Patients in group A were more likely to have inadequate response at both 30 and 60 min while patients in group B were more likely to have normal response at both time points.ConclusionsOur results suggest that about 5% of people undergoing SST may be inappropriately diagnosed as having AI (and subjected to long-term unnecessary steroid treatment) if the 60 min sample is not maintained. We suggest that 30 min sample does not add any additional diagnostic utility and can be omitted thus simplifying SST even further and saving on cost and resources. We propose that single measurement after 60 min of administration of synthetic ACTH is a sufficient screening test for AI.

The short Synacthen test: is less best?

1999 ◽  
Vol 51 (2) ◽  
pp. 151-152 ◽  
Author(s):  
Paul M. Stewart ◽  
Penny Clark
Keyword(s):  
Synacthen Test ◽  
Short Synacthen Test
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