Endocrine Abstracts

Short Synacthen test (SST) is performed to exclude adrenal insufficiency; it’s frequently used for investigations of hyponatremia to rule out adrenal insufficiency as a possible cause. However the cost of Synacthen^® (tetracosactide) 250 μg in 1 ml has increased from £14.63 to £228.55 for box of 5 A. (15-fold rise in price). This price hike needs to be taken into considerations when ordering SST. The objective of this retrospective audit was to see if patient selection was appropriate for SST. We audited inpatient SST tests performed at two hospital sites in our Trust during the first quarter of year 2015 in medical wards. Fifty-seven charts were audited to see if clinical features suggested cortisol deficiency and SST was justified. Twenty-three (40%) patient’s had sign and symptoms suggestive of possible adrenal insufficiency and out of these only three patients had positive SST and sodium was normal in all three patients. Twenty-seven patients had SST test performed for investigation of hyponatremia (of these only 12% had signs and symptoms suggestive of possible adrenal insufficiency), SST was normal in all 27 patients. We conclude 55% of SST performed were inappropriate as clinical features did not suggest adrenal insufficiency. Hyponatremia is a common finding and SST is not appropriate test unless history is suggestive of adrenal insufficiency. Given the new cost we now use random cortisol levels as screening test for suspected insufficiency in inpatient setting and if levels are 500 nmol/l or more we do not recommend SST unless there is high suspicion of primary or secondary cortisol deficiency.