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Utility of the low-dose short Synacthen test in diagnosis of adrenal insufficiency in outpatients with nonspecific symptoms

Author(s): Anne Corbould | Matthew Jarvis | Joanne Campbell | Deborah Kunde | Wade Clarkson | Denise Burns

Journal: Endocrinology Studies
ISSN 2038-9515

Volume: 2;
Issue: 2;
Start page: e5;
Date: 2012;
Original page

Keywords: adrenal insufficiency/diagnosis | cosyntropin/diagnostic use | humans | outpatients

Short Synacthen tests are used to diagnose primary and secondary adrenal insufficiency. The standard test uses supraphysiological adrenocorticotropic hormone (250 μg). The low-dose test (1 μg) was proposed to be more sensitive. In outpatients with nonspecific symptoms referred for exclusion of adrenal insufficiency, we assessed whether the low-dose test was an appropriate initial investigation. Results of 233 low-dose tests were obtained from pathology database 2007-2009. Clinical data were available for 169 patients: 37 taking glucocorticoids or with known pituitary/adrenal disease were excluded. Among the remaining 132 patients, 26% failed using stimulated cortisol ≥500 nmol/L and 45% failed at ≥550 nmol/L. These rates of apparent adrenal insufficiency are ~50 fold above expected. In conclusion, the low-dose test, using conventional criteria for normality, is abnormal in a large proportion of patients with nonspecific symptoms. Until criteria for normal cortisol response to low-dose Synacthen are clarified, alternative tests of adrenal function are advised in this clinical setting.
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