SFEIES24 Poster Presentations Adrenal & Cardiovascular (40 abstracts)
Comparison of a morning serum cortisol concentration against a morning salivary cortisone concentration to predict the outcome of a short synacthen test
Julie Martin-Grace 1 , Sarah Lawless 1 , Maria Tomkins 1,2 , Tara McDonnell 1,2 , Leanne Cussen 1,2 , Karl Hazel 1 , Karen Heverin 1 , Shari Srinivasan 1 , Brian Keevil 3,4 , Aoibhlinn O’Toole 1 , Richard Costello 1,2 , Michael W. O’Reilly 1,2 & Mark Sherlock 1,2
1Beaumont Hospital, Dublin, Ireland; 2Royal College of Surgeons in Ireland, Dublin, Ireland; 3Manchester University NHS Foundation Trust, Manchester, United Kingdom; 4Manchester Academic Health Sciences Centre, Manchester, United Kingdom
The short synacthen test (SST) is a well-established method to assess adrenal function. Recent data has suggested a waking salivary cortisone may be a more convenient alternative to serum cortisol testing to predict SST outcome. This study compares the performance of a 9am serum cortisol sample to a simultaneous 9am salivary cortisone sample to predict SST outcome, to establish which method results in a greater reduction in SST requirements. We recruited 122 participants to undergo an SST with paired baseline serum cortisol, salivary cortisone, ACTH and DHEAS concentration. Receiver-operating characteristics (ROC) curve analysis demonstrated that both serum cortisol and salivary cortisone are good predictors of SST response (AuROC 0.96 and AuROC 0.92, respectively). All participants with a morning serum cortisol <117 nmol/l failed the SST (100% specificity, 42% sensitivity). All those with a morning serum cortisol >266 nmol/l passed the SST (100% specificity, 71% sensitivity). If SST were performed only when morning serum cortisol was indeterminate (117-266 nmol/l), 64% of SSTs could be avoided. All participants with 9am salivary cortisone concentration <8.58 nmol/l failed the SST (99% specificity, 45% sensitivity) and all those with 9am salivary cortisone >41.1 nmol/l passed the SST (100% specificity, 29% sensitivity), reducing SST requirements by 34%. Where serum cortisol concentration was indeterminate (117-266 nmol/l) (n = 42), the addition of a morning salivary cortisone concentration did not significantly reduce the need for SST compared with serum cortisol concentration alone (P = 0.68). Participants with a low morning cortisol (<266 nmol/l) and low DHEAS concentration were more likely to fail the SST than those with a low cortisol alone (RR 3.54, P = 0.004). Serum cortisol (9am) resulted in a much greater potential reduction in SST requirement than salivary cortisone (9am). The timing of sample collection appears to be a key determinant in the use of salivary cortisone to predict SST outcome.
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Endocrine Abstracts
ISSN 1470-3947 (print) | ISSN 1479-6848 (online)
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