<b>Comparison of tests of stress‐released cortisol secretion in pituitary disease</b>

Orme, Stephen M.; Peacey, Steven R.; Barth, Julian H.; Belchetz, P. E.

doi:10.1046/j.1365-2265.1996.d01-1562.x

Cited by 54 publications

(46 citation statements)

References 24 publications

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“…Therefore, many authors suggest raising cortisol cutoff level to 20 -22 μg/dL [16,17] or even higher [14,18]. At the cortisol cutoff of 20 μg/dL, the sensitivity increases to 83% [19]. Furthermore, Kazlauskaite et al calculated that the normal HPA axis is best predicted when cortisol is above 30 μg/dL at 30 min [18].…”

Section: Discussionmentioning

confidence: 99%

The Caveats of Corticotropin Stimulation Test in Diagnosing Secondary Adrenal Insufficiency: Case Reports and Literature Review

et al. 2016

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Corticotropin stimulation test (CST) is commonly used to diagnose secondary adrenal insufficiency. We present two patients who underwent transsphenoidal pituitary surgery for pituitary macroadenoma. Both patients had additional pituitary hormone deficiencies before and after the surgery. The patients were maintained on glucocorticoid (GC) replacement for at least 3 months after the surgery. In the remote follow-up period, they underwent conventional CST with resultant cortisol levels above 18 μg/dL. This led to discontinuation of GC treatment. Few months later, both patients developed clinically evident adrenal insufficiency. Providers should be cautious interpreting the results of CST in patients with pituitary disorders. The 250-μg CST with standard cortisol cutoff has low sensitivity and can give falsely reassuring results. Thus, it is prudent to use a higher cortisol threshold to define intact hypothalamic-pituitary-adrenal axis.

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Section: Discussionmentioning

confidence: 99%

The Caveats of Corticotropin Stimulation Test in Diagnosing Secondary Adrenal Insufficiency: Case Reports and Literature Review

et al. 2016

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“…580 nmol/l (1). Since then, the 'pass' value has been modified to account for the increased specificity of modern cortisol assays, a value of 500 nmol/l being adopted as being equivalent to 580 nmol/l (4,10,15,16). This is the minimal cortisol response that is deemed safe for individuals to undergo maximal stress such as surgery.…”

Section: Discussionmentioning

confidence: 99%

“…For the IST it was necessary that the maximum cortisol level was more than 500 nmol/l for it to be classified as a 'pass'. A plasma cortisol value of 500 nmol/l is equivalent to 580 nmol/l (1) since the old fluorimetric assay has a 20-30% positive bias compared with radioimmunoassay of cortisol (16) over the 300-900 nmol/l range of plasma cortisol (15). Plasma cortisol was measured by the assay currently in use at the time which was either a radioimmunoassay (Amerlex, Amersham International plc, Aylesbury, Bucks, UK) or after 1990 a non-isotopic immunoassay (Abbott TDX, Diagnostics Division, IL, USA) with intra-assay and interassay coefficients of variation of 3-4% and 4-7% respectively.…”

Section: Methodsmentioning

confidence: 99%

“…Twenty-four percent of UK endocrinologists adopted the SST as a first line test in 1988 (4) and 50 percent had adopted it by 1995 (9). Whilst the majority of studies show close correlation between the responses to the two tests (3,4,10), discrepancies have been demonstrated (11)(12)(13)(14)(15), leading some to rely on the IST as the first line test despite its unpleasantness.…”

Section: Introductionmentioning

confidence: 99%

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How reliable is the short synacthen test for the investigation of the hypothalamic-pituitary-adrenal axis?

Bangar

Clayton²

1998

European Journal of Endocrinology

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The best test for the assessment of the hypothalamic-pituitary-adrenal (HPA) axis remains a matter of controversy. We compared the performance of the short synacthen test (SST, 250 mg) with the insulin stress test (IST) to assess the reliability of the former as a first line test. Patients with pituitary disease underwent both the SST and the IST. The results in patients who had both tests within 4 weeks of each other, and where these were not separated by a therapeutic intervention, were compared. Basal, 30 and 60 min cortisol levels were obtained from the SST. Basal and maximal cortisol level after adequate hypoglycaemia (glucose < 2.2 mmol/l) were recorded for the IST.Sixty-nine paired test results were available for analysis. With a 30 min 'pass' plasma cortisol value of 500 nmol/l on the SST, 7/69 (10%) patients who passed the SST failed the IST set at a 'pass' maximum value of 500 nmol/l. At a 'pass' cortisol value of 600 nmol/l on the SST, 3/69 (4%) who passed the SST failed the IST. Assuming the IST as the gold standard, the sensitivity of an SST 'pass' of 600 nmol/l is 85% with a specificity of 96%.During the conventional dose SST (250 mg) a 30 min plasma cortisol value of 600 nmol/l is more reliable than a value of 500 nmol/l, and using the former criterion the SST can safely be used as a first line test for the evaluation of the HPA axis in patients with pituitary disease. However, if the result is borderline or there is clinical suspicion of mild hypocorticotrophism an IST or other test of the HPA axis may be warranted.

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“…The SST has been criticised [56,57] and a number of case reports have documented instances in which the short synacthen test failed to diagnose unequivocally symptomatic secondary hypoadrenalism [58,59]. The SST may be less reliable in assessing the HPA axis in patients withdrawing from steroids [60,61], those with pituitary disease [62] and in the first 14 days following pituitary surgery [63].…”

Section: The Short Synacthen Test (Sst)mentioning

confidence: 99%