Searchable abstracts of presentations at key conferences in endocrinology
Endocrine Abstracts (2019) 65 P28 | DOI: 10.1530/endoabs.65.P28

SFEBES2019 POSTER PRESENTATIONS Adrenal and Cardiovascular (78 abstracts)

Recalibration of thinking about adrenocortical function assessment: How the random cortisol relates to the short Synacthen test ‘Verdict’

Maria Michaelidou 1 , Ghasem Yadegarfar 2 , Adam Robinson 1 , Asma Naseem 1 , Inamullah Khan 1 , Rupinder Kochhar 1 , Jonathan Scargill 1 , Peter Trainer 3, & Adrian Heald 1,

1Salford Royal Hospital, Salford, UK; 2Isfahan University of Medical Sciences, Isfahan, Islamic Republic of Iran; 3The Christie Hospital, Manchester, UK; 4University of Manchester, Manchester, UK

Background: The short synacthen test (SST) is the most commonly performed investigation to assess for suspected adrenocortical dysfunction. We investigated how random cortisol levels may relate to pass/fail on the STT.

Methods: We analysed the relation between random cortisol measurements taken between 04.40 and 20.52 in the day and results of SST baseline and 30/60 min cortisol performed over a 12 month period (338 SSTs) at Salford Royal Hospital. Serum cortisol was measured on the Siemens Centaur Autoanalyser (Erlangen, Germany). A 30/60 minute cortisol of ≥500 nmol/l in the presence of a baseline of ≥200 nmoll was taken as a ‘pass’. Failure of cortisol to reach 350 nmol/l post-Synacthen was taken as a definite fail.

Results: The findings indicate that a random cortisol level of ≥195nmol/l is associated with a ‘pass’ on the STT in 100% of cases. A random cortisol level of 95 nmol/l or less was associated with a ‘fail’ on the STT in 100% of cases. Overall there was no significant relation between random cortisol and 30 min post-Synacthen cortisol. In relation to the agreed ‘pass’ cut off post-Synacthen of cortisol ≥500 nmol/l, in 8.5% of cases the 60 min cortisol was ≥500 nmol/l but 30 min cortisol was below. Thus the 60 min cortisol indicated adequate adrenocortical function. In 0.5% of cases the converse was true. For a definite fail of cortisol <350 nmol/l there was disagreement between 30 and 60 min cortisol in 10 cases. In 30% of these cases the 60 minute cortisol was ≥350 nmol/l but the 30 min cortisol was below 350 nmol/l. In other words.

Conclusion: Our findings suggest that in the if the random cortisol level is ≥195 nmol/l, there may be no need to perform a SST unless specific evaluation is required. In 8.3% of cases an adequate cortisol response was seen at 60 min but not at 30 min. The 60 min cortisol therefore retains utility.

Volume 65

Society for Endocrinology BES 2019

Brighton, United Kingdom
11 Nov 2019 - 13 Nov 2019

Society for Endocrinology 

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