Validated criteria for the interpretation of a single measurement of serum cortisol in the investigation of suspected adrenal insufficiency

Clinical Endocrinology
Scott D MackenzieFraser W Gibb

Abstract

The diagnostic value of a single measurement of serum cortisol as a first step in the investigation of suspected adrenal insufficiency remains unclear. Previously proposed criteria have not been validated, and little is known regarding the performance of the test outwith morning samples in outpatients. We aimed to identify and validate criteria for morning and afternoon serum cortisol which could be used to determine which individuals require dynamic testing, in both outpatient and medical inpatient settings. We performed a retrospective analysis of 2768 patients attending endocrinology clinics and patients admitted to general medical units in two hospitals in Edinburgh, UK. In baseline samples from the short synacthen test, thresholds which identified a subnormal-stimulated serum cortisol (<430 nmol/L using the Abbott Architect assay) with 95% sensitivity were identified. Criteria drawn from data in patients attending outpatient clinics in one hospital were tested in additional outpatient and inpatient validation cohorts. A morning (8 am-12 pm) serum cortisol of <275 nmol/L identified subnormal-stimulated cortisol with 96.2% sensitivity. For afternoon (12 pm-6 pm) samples, a cut-off of <250 nmol/L achieved 96.1% sensitivity. S...Continue Reading

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Citations

Nov 19, 2019·PloS One·Worapaka ManosroiPichitchai Atthakomol
Apr 9, 2021·Frontiers in Endocrinology·Arturo PencoGianluca Tornese
Jun 19, 2021·Molecular Genetics and Metabolism·Anna ČechováKyriakie Sarafoglou
Oct 8, 2021·Journal of Human Hypertension·Tomáš ZelinkaJiří Widimský

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