Investigating the Clinical Appropriateness of Short Synacthen Testing and Utility of Pretest Cortisol to Predict Short Synacthen Testing Outcomes: A Tertiary Center Experience in Southeast Asia.

IF 3.7 3区 医学 Q2 ENDOCRINOLOGY & METABOLISM Endocrine Practice Pub Date : 2024-10-18 DOI:10.1016/j.eprac.2024.10.006
Pei Chia Eng, Vijay Ramadoss, Li Ying Lyeann Tan, Li Zhen Ong, Doddabele Srinivasa Deepak, Chin Meng Khoo
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Abstract

Objective: No studies have investigated the predictors of an adequate cortisol response to the short synacthen test (SST) and the appropriateness of patient selection for SST in the Southeast Asian population. The aim of our study is to investigate the predictors and indications of SSTs and concondance of SSTs conducted with outcomes.

Methods: This is a retrospective study investigating all SSTs performed over a year in a tertiary center. Clinical data of patients with SSTs between February 2022 and February 2023 were extracted. We determined the appropriateness of SST testing. Binary logistic regression was used to assess the parameters that predict adequate cortisol response on SST. The proportion of individuals with biochemical "pass" or "fail" on SST was compared with the Χ2 test. Baseline cortisol levels that predicted SST pass were determined using area under receiving operating characteristics curves.

Results: Of the 781 SSTs, 83.9% of SSTs showed an adequate cortisol response. Postural hypotension (26.9%) and exogenous glucocorticoid administration (14.2%) were common indications for SST. In our cohort, 50.2% of the SSTs were inappropriately indicated. Pretest serum cortisol and albumin predict biochemical pass on SST. A pretest cortisol level of 300 nmol/L predicted SST response with 93% sensitivity and a cortisol level of <100 nmol/L confirmed adrenal insufficiency (AI) with 97.3% specificity. Using these cortisol thresholds could avoid 302 (38.5%) of SSTs.

Conclusion: Our analysis showed that clinical features of AI do not reliably predict SST outcomes. We advocate careful assessment of the pretest probability of AI in patients referred for SST. A pretest cortisol level can reduce the number of SSTs, with cost savings implications.

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研究短期综合征测试(SST)的临床适宜性以及测试前皮质醇对预测 SST 结果的作用:东南亚一家三级中心的经验。
背景:尚未有研究调查东南亚人群对短同步测试(SST)皮质醇充分反应的预测因素,以及选择 SST 患者的适当性:目的:调查SST的预测因素、适应症以及与SST结果的一致性:设计:一项回顾性研究,调查一家三级医疗中心一年内实施的所有 SST:我们提取了2022年2月至2023年2月期间接受SST的患者的临床数据。我们确定了 SST 检测的适当性。二元逻辑回归用于评估预测皮质醇对 SST 充分反应的参数。通过卡方检验比较了 SST 生化检测 "通过 "或 "未通过 "的人数比例。使用 AuROC 曲线确定了预测 SST 通过的皮质醇基线水平:在 781 次 SST 中,83.9% 的 SST 显示皮质醇反应充分。体位性低血压(26.9%)和外源性 GC 给药(14.2%)是 SST 的常见适应症。在我们的队列中,50.2% 的 SST 使用不当。测试前血清皮质醇和白蛋白可预测 SST 的生化合格率。检测前皮质醇水平达到 300nmol/L 可预测 SST 反应,灵敏度为 93%;皮质醇水平低于 100nmol/L 可确认肾上腺功能不全 (AI),特异性为 97.3%。使用这些皮质醇阈值可避免 302 例(38.5%)SST:我们的分析表明,AI 的临床特征并不能可靠地预测 SST 的结果。我们主张对转诊接受 SST 的患者进行仔细的 AI 检测前概率评估。测试前的皮质醇水平可减少 SST 的次数,从而节约成本。
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来源期刊
Endocrine Practice
Endocrine Practice ENDOCRINOLOGY & METABOLISM-
CiteScore
7.60
自引率
2.40%
发文量
546
审稿时长
41 days
期刊介绍: Endocrine Practice (ISSN: 1530-891X), a peer-reviewed journal published twelve times a year, is the official journal of the American Association of Clinical Endocrinologists (AACE). The primary mission of Endocrine Practice is to enhance the health care of patients with endocrine diseases through continuing education of practicing endocrinologists.
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