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

Michaelidou, Maria; Yadegarfar, Ghasem; Morris, Lauren; Dolan, Samantha B.; Robinson, Adam; Naseem, Asma; Livingston, Mark; Duff, Christopher J; Aamir, Azizul Hasan; Fryer, Anthony A.; Trainer, Peter; Heald, Adrian

doi:10.1111/ijcp.14417

Cited by 2 publications

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“…Adrenal insufficiency, adrenal crisis, glucocorticoid, pituitary DOI: 10.7861/clinmed.2023-0067 Concerns have been raised about false positive diagnoses of adrenal insufficiency if relying on 30-minute cortisol values in isolation and clinical judgement is required when interpreting the results, taking into account pre-test probability. 5,6 This can be used to determine primary adrenal insufficiency and secondary pituitary causes which lead to adrenal atrophy because of inadequate ACTH production. It is important to note that this test is not reliable in diagnosing secondary adrenal insufficiency within 2 weeks of pituitary surgery.…”

Section: Introductionmentioning

confidence: 99%

Diagnosis and management of adrenal insufficiency

Lewis

Thant²,

Aslam³

et al. 2023

Clinical Medicine

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Adrenal insufficiency is the inadequate secretion of glucocorticoid and/or mineralocorticoid secretion from the adrenal cortex. Primary adrenal insufficiency is the result of failure of the adrenal gland and secondary adrenal insufficiency is due to a lack of stimulation via pituitary adrenocorticotropic hormone or hypothalamic corticotropinreleasing hormone. Adrenal insufficiency may cause non-specific symptoms. Early detection and testing based on clinical suspicion may prevent subsequent presentation with adrenal crisis. Once identified, a low baseline cortisol (often <100 nmol/L) alongside raised adrenocorticotropic hormone (ACTH) can be enough to diagnose primary adrenal insufficiency. However, confirmatory testing can be done using the cosyntopin (Synacthen ® ) stimulation test or the insulin tolerance test, which is the gold standard for secondary adrenal insufficiency. The underlying cause of adrenal insufficiency can often be identified via a strategic approach to investigation. Adrenal crisis is a life-threatening medical emergency which must be treated immediately if there is strong clinical suspicion with fluids and corticosteroids otherwise can be fatal. Patients must be educated and empowered to take control of their own medical management.

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Section: Introductionmentioning

confidence: 99%