A systematic review and meta-analysis of Synacthen tests for assessing hypothalamic-pituitary-adrenal insufficiency in children

Ng, Sze May; Agwu, Juliana Chizo; Dwan, Kerry

doi:10.1136/archdischild-2015-308925

Cited by 30 publications

(18 citation statements)

References 52 publications

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“…The low‐dose synacthen test (most commonly 1 mcg) is used by some clinicians, as it is thought to more closely mimic a physiological stress stimulus to the adrenal cortex . Results of meta‐analyses do not show significant superiority of one test over another, and both doses are used in clinical practice …”

Section: Introductionmentioning

confidence: 99%

“…14 Results of meta-analyses do not show significant superiority of one test over another, and both doses are used in clinical practice. [16][17][18][19][20] The measurement of salivary cortisol has been used after stimulation, with different doses of synacthen, in both healthy volunteers and patients. [3][4][5][6]8,10 The results support the use of salivary sampling after synacthen, particularly in groups with low serum steroid binding-protein levels and women on estrogens.…”

Section: Introductionmentioning

confidence: 99%

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Use of salivary cortisol and cortisone in the high‐ and low‐dose synacthen test

Elder

Harrison

Cross

et al. 2017

Clinical Endocrinology

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Section: Introductionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Use of salivary cortisol and cortisone in the high‐ and low‐dose synacthen test

Elder

Harrison

Cross

et al. 2017

Clinical Endocrinology

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“…The low-dose ACTH test works as a more physiological simulation of the adrenal function in stress situations. Standard-dose ACTH test has a higher specificity while low-dose is more sensitive but has a lower specificity [6]. Stimulation tests give us more extensive information about the adrenal function than basal cortisol measurements.…”

Section: Discussionmentioning

confidence: 99%

Adrenal function after induction therapy for acute lymphoblastic leukemia in children short: adrenal function in ALL

2020

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Prednisolone used in the induction phase of the treatment of acute lymphoblastic leukemia (ALL) may suppress hypothalamic-pituitary-adrenal axis and require hydrocortisone substitution. In this retrospective analysis, we reviewed altogether 371 ACTH stimulation tests of 352 children after a uniform NOPHO (Nordic Society of Pediatric Hematology and Oncology) ALL induction. Both low-and standard-dose ACTH tests were used. Full recovery of adrenal function was defined by both normal basal and stimulated cortisol levels. Sixty-two percent of patients were detected with normal adrenal function in median of 15 days after tapering of prednisolone. Both low basal and stimulated cortisol levels were detected in 13% of patients. The median time to normal adrenal function was 31 days (95% CI 28-34), 24 days (95% CI 18-30), and 12 days (95% CI 10-14) for those with basal cortisol <107, 107-183, and >183 nmol/L at first ACTH testing, respectively. Patients with fluconazole prophylaxis had higher median baseline cortisol levels compared to patients without prophylaxis (207 nmol/L, range 21-839 nmol/L vs. 153 nmol/L, range 22-832 nmol/L, P = 0.003).Conclusion: These data can be used to reduce unnecessary substitution or testing, but also to guarantee hydrocortisone substitution for those at risk. What is Known:•These data can be used to reduce unnecessary hydrocortisone substitution or ACTH testing. •Our data helps to guarantee hydrocortisone substitution for those at risk of adrenal insufficiency. What is New:•Full recovery of adrenal function after ALL induction is detected in 62% of patients already at 15 days after tapering of prednisolone.•Both basal and stimulated cortisol testing are required for detection of full adrenal recovery.•Recovery time of adrenal function is extended over 3-4 weeks after tapering of prednisolone in patients with low basal cortisol levels (<107 nmol/L) at first testing.

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“…Seriously ill patients often have low plasma protein concentration, making total cortisol analysis difficult [76]. Alternatively, assays to measure free cortisol must be very sensitive and there is a lack of standardization between different commercially available kits [77]. …”

Section: Fatiguementioning

confidence: 99%

Hypothalamic Dysfunction and Multiple Sclerosis: Implications for Fatigue and Weight Dysregulation

Burfeind

Yadav

Marks

2016

Curr Neurol Neurosci Rep

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Signs and symptoms of multiple sclerosis are usually attributed to demyelinating lesions in the spinal cord or cerebral cortex. The hypothalamus is a region that is often overlooked yet controls many important homeostatic functions, including those that are perturbed in multiple sclerosis. In this review we discuss how hypothalamic dysfunction may contribute to signs and symptoms in people with multiple sclerosis. While dysfunction of the hypothalamic-pituitary-adrenal axis is common in multiple sclerosis, the effects and mechanisms of this dysfunction are not well understood. We discuss three hypothalamic mechanisms of fatigue in multiple sclerosis: (1) general hypothalamic-pituitary-adrenal axis hyperactivity, (2) disordered orexin neurotransmission, (3) abnormal cortisol secretion. We then review potential mechanisms of weight dysregulation caused by hypothalamic dysfunction. Lastly, we propose future studies and therapeutics to better understand and treat hypothalamic dysfunction in multiple sclerosis. Hypothalamic dysfunction appears to be common in multiple sclerosis, yet current studies are underpowered and contradictory. Future studies should contain larger sample sizes and standardize hormone and neuropeptide measurements.

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A systematic review and meta-analysis of Synacthen tests for assessing hypothalamic-pituitary-adrenal insufficiency in children

Cited by 30 publications

References 52 publications

Use of salivary cortisol and cortisone in the high‐ and low‐dose synacthen test

Use of salivary cortisol and cortisone in the high‐ and low‐dose synacthen test

Adrenal function after induction therapy for acute lymphoblastic leukemia in children short: adrenal function in ALL

Hypothalamic Dysfunction and Multiple Sclerosis: Implications for Fatigue and Weight Dysregulation

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