The short Synacthen (corticotropin) test can be used to predict recovery of hypothalamo-pituitary-adrenal axis function
The 250μg Short Synacthen (corticotropin) Test (SST) is the most commonly used tool to assess hypothalamo-pituitary-adrenal (HPA) axis function. There are many potentially reversible causes of adrenal insufficiency (AI), but currently no data to guide clinicians as to the frequency of repeat testing...
| Main Authors: | , , , , , , , , , , |
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| Format: | Journal article |
| Language: | English |
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Oxford University Press
2018
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| _version_ | 1797084912994484224 |
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| author | Pofi, R Feliciano, C Sbardella, E Argese, N Woods, C Grossman, A Jafar-Mohammadi, B Gleeson, H Lenzi, A Isidori, A Tomlinson, J |
| author_facet | Pofi, R Feliciano, C Sbardella, E Argese, N Woods, C Grossman, A Jafar-Mohammadi, B Gleeson, H Lenzi, A Isidori, A Tomlinson, J |
| author_sort | Pofi, R |
| collection | OXFORD |
| description | The 250μg Short Synacthen (corticotropin) Test (SST) is the most commonly used tool to assess hypothalamo-pituitary-adrenal (HPA) axis function. There are many potentially reversible causes of adrenal insufficiency (AI), but currently no data to guide clinicians as to the frequency of repeat testing or likelihood of HPA axis recovery.To use the SST results to predict recovery of adrenal function.A retrospective analysis of data from 1912 SSTs.776 patients with reversible causes of AI were identified who had at least two SSTs performed. A subgroup analysis was performed on individuals previously treated with suppressive doses of glucocorticoids (n=110).Recovery of HPA axis function.SST 30-minute cortisol levels above or below 350nmol/L (12.7μg/dL) best predicted HPA axis recovery (AUC ROC=0.85; median recovery time 334 vs. 1368 days, p=8.5x10-13): 99% of patients with a 30-minute cortisol >350nmol/L recovered adrenal function within 4-years, compared with 49% in those with cortisol levels <350nmol/L. In patients exposed to suppressive doses of glucocorticoids, delta cortisol (30-minute - basal) was the best predictor of recovery (AUC ROC = 0.77; median recovery time 262 vs. 974 days, p=7.0x10-6). No patient with a delta cortisol <100nmol (3.6μg/dL) and a subsequent random cortisol <200nmol/L (7.3μg/dL) measured approximately 1-year later recovered HPA axis function.Cortisol levels across an SST can be used to predict recovery of AI and may guide the frequency of repeat testing and inform both clinicians and patients as to the likelihood of restoration of HPA axis function. |
| first_indexed | 2024-03-07T02:01:49Z |
| format | Journal article |
| id | oxford-uuid:9da42fdb-bbca-46c4-949a-529d88170dae |
| institution | University of Oxford |
| language | English |
| last_indexed | 2024-03-07T02:01:49Z |
| publishDate | 2018 |
| publisher | Oxford University Press |
| record_format | dspace |
| spelling | oxford-uuid:9da42fdb-bbca-46c4-949a-529d88170dae2022-03-27T00:44:31ZThe short Synacthen (corticotropin) test can be used to predict recovery of hypothalamo-pituitary-adrenal axis functionJournal articlehttp://purl.org/coar/resource_type/c_dcae04bcuuid:9da42fdb-bbca-46c4-949a-529d88170daeEnglishSymplectic Elements at OxfordOxford University Press2018Pofi, RFeliciano, CSbardella, EArgese, NWoods, CGrossman, AJafar-Mohammadi, BGleeson, HLenzi, AIsidori, ATomlinson, JThe 250μg Short Synacthen (corticotropin) Test (SST) is the most commonly used tool to assess hypothalamo-pituitary-adrenal (HPA) axis function. There are many potentially reversible causes of adrenal insufficiency (AI), but currently no data to guide clinicians as to the frequency of repeat testing or likelihood of HPA axis recovery.To use the SST results to predict recovery of adrenal function.A retrospective analysis of data from 1912 SSTs.776 patients with reversible causes of AI were identified who had at least two SSTs performed. A subgroup analysis was performed on individuals previously treated with suppressive doses of glucocorticoids (n=110).Recovery of HPA axis function.SST 30-minute cortisol levels above or below 350nmol/L (12.7μg/dL) best predicted HPA axis recovery (AUC ROC=0.85; median recovery time 334 vs. 1368 days, p=8.5x10-13): 99% of patients with a 30-minute cortisol >350nmol/L recovered adrenal function within 4-years, compared with 49% in those with cortisol levels <350nmol/L. In patients exposed to suppressive doses of glucocorticoids, delta cortisol (30-minute - basal) was the best predictor of recovery (AUC ROC = 0.77; median recovery time 262 vs. 974 days, p=7.0x10-6). No patient with a delta cortisol <100nmol (3.6μg/dL) and a subsequent random cortisol <200nmol/L (7.3μg/dL) measured approximately 1-year later recovered HPA axis function.Cortisol levels across an SST can be used to predict recovery of AI and may guide the frequency of repeat testing and inform both clinicians and patients as to the likelihood of restoration of HPA axis function. |
| spellingShingle | Pofi, R Feliciano, C Sbardella, E Argese, N Woods, C Grossman, A Jafar-Mohammadi, B Gleeson, H Lenzi, A Isidori, A Tomlinson, J The short Synacthen (corticotropin) test can be used to predict recovery of hypothalamo-pituitary-adrenal axis function |
| title | The short Synacthen (corticotropin) test can be used to predict recovery of hypothalamo-pituitary-adrenal axis function |
| title_full | The short Synacthen (corticotropin) test can be used to predict recovery of hypothalamo-pituitary-adrenal axis function |
| title_fullStr | The short Synacthen (corticotropin) test can be used to predict recovery of hypothalamo-pituitary-adrenal axis function |
| title_full_unstemmed | The short Synacthen (corticotropin) test can be used to predict recovery of hypothalamo-pituitary-adrenal axis function |
| title_short | The short Synacthen (corticotropin) test can be used to predict recovery of hypothalamo-pituitary-adrenal axis function |
| title_sort | short synacthen corticotropin test can be used to predict recovery of hypothalamo pituitary adrenal axis function |
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