Comparison of low‐dose and high‐dose cosyntropin stimulation testing in children

“…e false-negative results may lead to premature discontinuation of cortisol replacement, which increase the risk of adrenal insufficiency in stress condition. We adopted the LDT in the study as it gives comparable and more accurate results than the HDT dose [15,[17][18][19]. What is more, it is reported that measuring cortisol at both 30 and 60 minutes following the ACTH stimulation test may be necessary to avoid overdiagnosing CAI [20].…”

Section: Discussionmentioning

confidence: 99%

Morning Serum Cortisol as a Predictor for the HPA Axis Recovery in Cushing’s Disease

Cui

Liu

Xiang

et al. 2021

International Journal of Endocrinology

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Background. The suppressed hypothalamic-pituitary-adrenal (HPA) axis after successful surgery for Cushing’s disease (CD) will recover in almost all patients. We aimed to identify the predictive factors for HPA axis recovery in CD patients with postoperative remission. Design and Methods. This observational retrospective cross-sectional study enrolled 69 CD patients with postoperative remission in Huashan Hospital from 2015 to 2019. All subjects had a detailed clinical evaluation. The low-dose ACTH stimulation test (LDT) was conducted as the gold standard for assessing the HPA axis function. Results. Peak cortisol in LDT was found only to be positively correlative with morning serum cortisol (MSC) ( ρ = 0.451 , p < 0.001 ). The MSC was higher ( p < 0.001 ), and the median postoperative course was significantly longer ( p = 0.025 ) in the patients with the recovered HPA axis function compared with unrecovered patients. The AUC value of MSC for predicting the recovery of the HPA axis was 0.701, and the optimal cutoff was 6.25 μg/dl (sensitivity 85.19% and specificity 47.62%). Other useful cutoff values were 10.74 μg/dl (specificity 100%) and 4.18 μg/dl (sensitivity 100%). Besides, combined with the postoperative course, the AUC values were higher than MSC alone (0.935 vs. 0.701, p < 0.001 ). Conclusions. MSC is a viable first-step diagnostic predictor for HPA axis recovery in CD patients with postoperative remission. For the patients with cortisol levels between 4.18 and 10.74 μg/dl, a confirmatory test should be conducted. When the MSC level was 10.74 μg/dl or greater, the replacement therapy could be discontinued.

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“…21 Additional studies suggest setting a lower level of 14 mcg/dL to avoid false positive results and to increase screening sensitivity. 24 This patient did not have a stimulation test and instead demonstrated low morning cortisol levels with a markedly elevated ACTH level (also diagnostic for AD).…”

Section: Diagnosis Of Apsmentioning

confidence: 91%

Autoimmune Polyendocrine Syndrome: A Case-Based Review

Schneller¹,

Finkel²,

Wise³

et al. 2013

Pediatr Ann

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Comparison of low‐dose and high‐dose cosyntropin stimulation testing in children

Abstract: LD cosyntropin stimulation testing results should be interpreted cautiously when used alone to prevent unnecessary long-term treatment. Using a lower cut-off for LD (≥14 µg/dL) seems to avoid false positive results and still detects most cases of impaired HPAA.

Cited by 9 publications

References 17 publications

Spectrum of clinical presentations and endocrinological findings of patients with septo-optic dysplasia: a retrospective study

Spectrum of clinical presentations and endocrinological findings of patients with septo-optic dysplasia: a retrospective study

Morning Serum Cortisol as a Predictor for the HPA Axis Recovery in Cushing’s Disease

Autoimmune Polyendocrine Syndrome: A Case-Based Review

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