Introduction: The short synacthen test (SST) is commonly used to assess the hypothalamic pituitary adrenal (HPA) axis in clinical practice. We evaluated the underlying clinical conditions pre-empting the request for a SST in a general medical ward and the adequacy of clinical follow up of patients with suboptimal responses to the test.
Methods: All patients with suboptimal SST results (30 min cortisol level 450540 nmol/l) performed in the Acute Assessment Unit in our hospital between 01/10/2007 to 30/09/2009 inclusive were analysed. All patients who were on steroid therapy for more than 1 month or were deceased were excluded from the analysis.
Results: One hundred and twenty-two patients were included in the study. The different clinical indications for performing SST were as follows; recurrent falls/postural hypotension, 47 patients(38.5%), weight loss, 17 patients (13.9%), hyponatremia, 14 patients (11.5%), pre-post pituitary surgery, 13 patients (1.7%) and others, 31 patients (25.4%). Of the 122 patients with suboptimal SST, 98 patients received further clinical follow up; 44 of which were consequently treated with steroids. Crucially this meant that 24 patients (19.6%) did not receive any further follow up as evidenced by the absence of any documentation in the clinical case notes.
Conclusions: The SST is a commonly used endocrinological test in clinical practice. The findings show that almost a fifth of patients tested with a SST may not be adequately followed up in clinical practice. The findings of the present study highlight a potential clinical risk as patients with disorders of the HPA axis are at increased risk of mortality and morbidity. It is essential that the results of all abnormal SSTs are brought into the attention of the referring physician and a referral made to the endocrinology for any cases where there is uncertainty.