Diagnostic performance of morning serum cortisol as an alternative to short synacthen test for the assessment of adrenal reserve; a retrospective study

2020 ◽  
pp. postgradmedj-2020-138514
Author(s):  
Rajeev Kumar ◽  
Peter Carr ◽  
Ws Wassif
Keyword(s):  
Retrospective Study ◽  
Cortisol Level ◽  
Serum Cortisol ◽  
Serum Cortisol Level ◽  
Number Of Patients ◽  
Morning Serum Cortisol ◽  
Insufficient Response ◽  
Synacthen Test ◽  
The Uk ◽  
Short Synacthen Test

ObjectiveThe short synacthen test (SST) is widely used across the UK to assess adrenal reserve. The main objective of our study was to determine the morning serum cortisol level that will predict adrenal insufficiency (AI) thus reducing our reliance on SST.DesignThis was a single centre retrospective study of 393 SST tests measuring 0 and 60 min cortisol levels after administration of 250 μg of synacthen (synthetic ACTH).Patients and methodsAll the SST tests for patients suspected of primary or secondary AI between April 2016 and October 2018 were included in this study. We used serum to determine circulating cortisol by a newer generation competitive electrochemiluminescence immunoassay (ECLIA) (Roche Diagnostics). A post-ACTH cortisol response of ≥420 nmol/L at 60 min was considered adequate to rule out AI. The data were analysed to ascertain the relationship between 0 min and 60 min serum cortisol.ResultsA total of 393 SST results were included in this study. Overall, a total of 332 (84.5%) subjects achieved sufficient serum cortisol level at 60 min, while 61 subjects (15.5%) showed insufficient response. Using the logistic regression, we determined that a morning basal serum cortisol level of ≥354 nmol/L was able to predict normal adrenal function with 100% sensitivity. We were unable to find a lower cut-off value below which SST will not be required. By using this proposed cut-off point, approximately 37% of the SSTs tests could be avoided.ConclusionsBasal morning serum cortisol can be safely used as a first step in the evaluation of patients with suspected AI. This will enhance the number of patients being screened for this condition.

Do we need 30 min cortisol measurement in the short synacthen test: a retrospective study

2019 ◽  
Vol 96 (1138) ◽  
pp. 467-472
Author(s):  
Rajeev Kumar ◽  
Peter Carr ◽  
Kimberley Moore ◽  
Zeeshan Rajput ◽  
Louise Ward ◽  
...  
Keyword(s):  
Retrospective Study ◽  
Adrenal Insufficiency ◽  
Late Response ◽  
Inadequate Response ◽  
Insufficient Response ◽  
Group A ◽  
Synacthen Test ◽  
Cortisol Levels ◽  
Group B ◽  
Short Synacthen Test

ObjectiveThe short synacthen test (SST) is widely used across the UK to assess adrenal reserve but there remains no consensus on the timing of cortisol sampling to help diagnose adrenal insufficiency. The main objective of our study was to see if both 30 and 60 min sample are required following administration of synacthen to investigate suspected adrenal insufficiency (AI).DesignThis was a single-centre retrospective study of 393 SSTs measuring 0, 30 and 60 min cortisol levels after administration of 250 µg of synacthen.Patients and methodsAll the SSTs for patients suspected of primary or secondary AI between April 2016 and October 2018 were included in this study. The tests were performed as per our hospital protocol. A post-adrenocorticotropic hormone (ACTH) cortisol response of 420 nmol/L at any time point was considered adequate to rule out AI. The data were analysed to ascertain the proportion of patients who achieved this level at 30 and/or 60 min.ResultsA total of 393 SST results were included in this study. Patients were divided into two groups depending on whether (group A) or not (group B) they were on steroids. Overall, a total of 313 (79.6%) subjects achieved cortisol level of ≥420 nmol/L at 30 and 60 min while 19 (4.8%) had late response (ie, insufficient 30 min cortisol levels, rising to ≥420 nmol/L at 60 min). Another 61 subjects (15.5%) showed insufficient response at both 30 and 60 min (ie, failed to achieved level of ≥420 nmol/L). Importantly, there was no patient in either group who had adequate response at 30 min and then failed at 60 min. Patients in group A were more likely to have inadequate response at both 30 and 60 min while patients in group B were more likely to have normal response at both time points.ConclusionsOur results suggest that about 5% of people undergoing SST may be inappropriately diagnosed as having AI (and subjected to long-term unnecessary steroid treatment) if the 60 min sample is not maintained. We suggest that 30 min sample does not add any additional diagnostic utility and can be omitted thus simplifying SST even further and saving on cost and resources. We propose that single measurement after 60 min of administration of synthetic ACTH is a sufficient screening test for AI.

scholarly journals Examination of associations between chaos in the home environment, serum cortisol level, and dietary fat intake among parents of preschool-age children

2017 ◽  
Vol 42 (7) ◽  
pp. 788-791 ◽  
Author(s):  
Laura M. MacRae ◽  
Gerarda Darlington ◽  
Jess Haines ◽  
David W.L. Ma ◽  
Keyword(s):  
Home Environment ◽  
Cortisol Level ◽  
Dietary Fat ◽  
Serum Cortisol ◽  
Preschool Age ◽  
Serum Cortisol Level ◽  
Fat Intake ◽  
Regression Analyses ◽  
Preschool Age Children ◽  
Morning Serum Cortisol

This research investigated associations between home-environment chaos, fat intake, and morning serum cortisol level in 44 parents of preschool-age children. Chaos was measured using the Confusion, Hubbub, and Order Scale, and fat intake was quantified using the Block fat screener. Linear regression analyses demonstrated that chaos and cortisol were both associated with fat intake ([Formula: see text] = 0.53, p = 0.001; [Formula: see text] = 0.03, p = 0.0002), and there was a nonsignificant association between chaos and cortisol.

Outcomes of the short Synacthen test: what is the role of the 60 min sample in clinical practice?

2019 ◽  
Vol 96 (1132) ◽  
pp. 67-72
Author(s):  
Rosemary Dineen ◽  
Ahmed Mohamed ◽  
Anjuli Gunness ◽  
Ana Rakovac ◽  
Emer Cullen ◽  
...  
Keyword(s):  
Serum Cortisol ◽  
Outpatient Setting ◽  
Serum Cortisol Level ◽  
Small Subset ◽  
Frequent Use ◽  
Retrospective Data Analysis ◽  
Synacthen Test ◽  
Optimum Sampling ◽  
Short Synacthen Test ◽  
Medical Disciplines

In recent years, the short Synacthen test (SS) has become the most widely used test to assess adrenal reserve. Despite its frequent use, there are still several areas related to the short Synacthen test (SST), which have no consensus including the optimum sampling times, that is, whether a 60 min post-Synacthen administration cortisol is necessary or not.MethodologyWe performed a retrospective data analysis of 492 SSTs performed on adult patients in a tertiary referral teaching hospital in Ireland. The SSTs were performed in the inpatient and outpatient setting and included patients across all medical disciplines and not exclusively to the endocrinology department.Results313 patients had 0, 30 and 60 min samples available for analysis. A total of 270/313 (82%) were deemed to pass the test, that is, cortisol ≥500 nmol/L at both 30 and 60 min. Of the 313 patients, 19 (6%) patients had an indeterminate response, cortisol <500 nmol/L at 30 min, but rising to ≥500 nmol/L on the 60 min sample. Of these 19 patients, only 9/19 patients had a serum cortisol level at 30 min <450 nmol/L, requiring clinical treatment with glucocorticoid replacement. All 24/313 (8%) patients who had insufficient responses at 60 min were also insufficient at 30 min sampling. No individuals passed (≥500 nmol/L) at 30 min and then failed (<500 nmol/L) at 60 min.ConclusionUsing the 30 min cortisol sample post-Synacthen administration alone identifies clinically relevant adrenal insufficiency in the majority of cases. A small subset of patients have a suboptimal response at 30 min but have a 60 min cortisol concentration above the threshold for a pass. Data regarding the long-term outcomes and management of such patients are lacking and require further study.

Higher morning serum cortisol level predicts increased fibrinogen but not shortened APTT

2007 ◽  
Vol 26 (2) ◽  
pp. 103-105 ◽  
Author(s):  
Giuseppe Lippi ◽  
Massimo Franchini ◽  
Gian Luca Salvagno ◽  
Martina Montagnana ◽  
Gian Cesare Guidi
Keyword(s):  
Cortisol Level ◽  
Serum Cortisol ◽  
Serum Cortisol Level ◽  
Morning Serum Cortisol

scholarly journals Effect of yoga and meditation on serum cortisol level in first-year medical students

2018 ◽  
Vol 6 (5) ◽  
pp. 1699
Author(s):  
Kislay Kumar ◽  
Vinay Singh ◽  
Devesh Kumar ◽  
A. B. Asthana ◽  
Divya Mishra
Keyword(s):  
Medical Students ◽  
Cortisol Level ◽  
Stress Level ◽  
High Stress ◽  
Serum Cortisol ◽  
Serum Cortisol Level ◽  
Control Group ◽  
P Value ◽  
Yoga Group ◽  
Morning Serum Cortisol

Background: Yoga is a traditional technique to conserve and purify body, mind and soul. It is a mind-body bridge which involves relaxation, meditation and a set of physical exercises performed in association with breathing. In this new era of evolution, most of the population are depressed or in stress, irrespective of their age and gender.Methods: This study is performed on 1st yr. medical students whose stress level is in higher side due to academic burden. An 55 medical students were selected as participants through counseling and were divided into yoga group (n= 27) and control group (n=28). Their morning serum cortisol level was assessed, and yoga group were instructed to practice yoga (1hr/day for 12 weeks) under supervision of yoga instructor. No such instruction was given to control group.Results: Serum cortisol level is the marker of stress and inflammation. Higher cortisol level means high stress level. Yoga and meditation is documented to reduce stress level in regular practitioners.  Statistical analysis has shown decrease in morning serum cortisol level (572.18±168.03 to 544.98±139.89, 4.8% decrease, P value ˂0.05, significant) in yoga group after study. Control group have shown marked increase in cortisol level (558.89±162.69 to 577.26±254.5, 3.4% increase, P value = 0.74, not significant) after three months of study.Conclusions: This study concludes that practicing Yoga has a significant effect on the reduction of stress and anxiety level in medical students.

Nighttime serum cortisol level for diagnosis of hypercortisolism in hospitalized patients

2019 ◽  
Author(s):  
Liana Khatsimova ◽  
Uliana Tsoy ◽  
Natalia Kuritsyna ◽  
Elena Grineva ◽  
Elena Litvinenko ◽  
...  
Keyword(s):  
Cortisol Level ◽  
Serum Cortisol ◽  
Hospitalized Patients ◽  
Serum Cortisol Level
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