ECE2015 Eposter Presentations Adrenal cortex (94 abstracts)
Outcomes of short synacthen test in a university teaching hospital: are baseline and time 30 min sufficient?
Mohamed Ahmed 1 , Gunness A 1 , Rakovac-Tisdall A 2 , Cullen E 1 , Barnwell N 1 , Neary C 1 , Boran G 2 , Gibney J 1 & Sherlock M 1
1Department of Endocrinology, The Adelaide and Meath Hospital incorporating the National Children’s Hospital, Tallaght, Dublin, Ireland; 2Department of Chemical Pathology, The Adelaide and Meath Hospital incorporating the National Children’s Hospital, Tallaght, Dublin, Ireland.
Introduction: Short synacthen test (SST) has become the standard method of assessing the hypothalamic–pituitary–adrenal (HPA) axis. However, there are still variances in practice with regards to performing and interpreting this test in particular the need for measuring cortisol level at both time 30 and 60 min.
Methods: A retrospective review of 500 consecutive SST performed at a University teaching Hospital in Dublin between 2005 and 2012. Serum cortisol was measured at time 0, 30, and 60 min following synacthen. A cortisol level of >500 nmol/l was considered adequate to out rule adrenal insufficiency.
Results: Out of 500 patients, 297 (59.4%) were females, and the average age was 57.4±19.3 years. 215 (43%) of subjects had at least one random cortisol level checked in the preceding 6 months prior to the synacthen test date, and the mean random cortisol for those who passed the test was 367.6±195.7 nmol/l compared to 133.5±81.8 in those who failed it, P<0.01. 225 (45%) of patients had at least one low serum sodium (<135 nmol/l) during the 6 months prior to test. Hyponatraemia was more prevalent in those who failed the test compared to those with adequate cortisol response (58% vs 43%, P<0.05).
438 (87.6%) patients passed their SST at both time 30 and 60 min and 53 (10.6%) failed it. In nine cases only (1.8%), the peak value of >500 nmol/l was achieved at time 60 but not at time 30 min.
Conclusion: Our data shows that patients with low random cortisol and hyponatraemia in the 6 months prior to the SST are likely to fail it. Measuring the baseline and time 30 min cortisol will lead to the correct diagnosis in over 98% of cases. Checking cortisol level at time 60 is of little added value in the majority of cases.
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Endocrine Abstracts
ISSN 1470-3947 (print) | ISSN 1479-6848 (online)
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