Abstract:
BACKGROUND:The short Synacthen test is widely used to assess the hypothalamus pituitary adrenal axis in the outpatient setting. In the inpatient setting however, technical difficulties to adhere to the protocol may pose a challenge for using this test. AIMS:In this study we attempted to find the most suitable basal serum cortisol cutoff for predicting an adequate response to the short Synacthen test in non-critically inpatients without conducting the actual test . METHODS:Information was retrieved retrospectively from medical files of 197 patients who had had a 250 mcg short Synacthen test between the years 2000-2016 at the Shaare Zedek Medical Center. Basal serum cortisol, electrolytes, creatinine, TSH, blood counts as well as blood pressure values were evaluated for a correlation with the results of the short Synacthen test. RESULTS:A basal serum cortisol cutoff of 280 nmol/l provides a negative predictive value of 94% for adrenal insufficiency. Using a cutoff of 380 nmol/l increases the sensitivity to 96% and yields a negative predictive value of 95.8% CONCLUSIONS: In this study we found two suitable basal serum cortisol cutoffs for predicting an adequate response to the short Synacthen test in hospitalized patients. We suggest using the lower cutoff (280 nmol\l) for patients with a low level of suspicion for adrenal insufficiency and using the higher cutoff (380 nmol\l) for patients with a higher level of suspicion. A basal serum cortisol above this cutoff makes the diagnosis of adrenal insufficiency very unlikely and precludes the need for a Synacthen test. This article is protected by copyright. All rights reserved.
journal_name
Intern Med Jjournal_title
Internal medicine journalauthors
Tolkin L,Vidberg M,Munter Gdoi
10.1111/imj.15033subject
Has Abstractpub_date
2020-08-24 00:00:00eissn
1444-0903issn
1445-5994pub_type
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