The effect of time of day testing and utility of 30 and 60 minute cortisol values in the 250 mcg ACTH stimulation test

Munro, Vicki; Elnenaei, Manal O.; Doucette, Steve; Clarke, David B.; Imran, Syed Ali

doi:10.1016/j.clinbiochem.2018.02.010

Cited by 18 publications

(12 citation statements)

References 20 publications

Supporting

Mentioning

Contrasting

Order By: Relevance

“…In this study, SST failure occurred in a higher percentage of subjects – (a) who had tests done between 8 and 10 am (Group 1) ( P = .001); and (b) who had SSTs done for ‘steroid related’ indications such as long-term steroid therapy, steroid withdrawal or a ‘low’ random cortisol ( P = .001) ( Table 1 ). While most studies report no influence of the timing of testing on SST outcome, 3 , 19 , 20 1 study reported a higher failure rate in the afternoon. 21 We cannot explain why our study is different, although 2 factors may be pertinent – (a) the proportion of patients with ‘steroid related’ indications (who had a higher failure rate) is not a plausible explanation as this was similar in Group 1 and Group 2 (P = .094); (ii) higher cortisol levels in the morning reflecting the cortisol circadian rhythm may necessitate a higher cut-off for diagnosing SST failure in Group 1.…”

Section: Discussionmentioning

confidence: 97%

See 1 more Smart Citation

Pre-test Cortisol Levels in Predicting Short Synacthen Test Outcome: A Retrospective Analysis

Ravindran

Carter

Kumar

et al. 2022

Clin Med Insights Endocrinol Diabetes

View full text Add to dashboard Cite

Objective: Short Synacthen tests (SSTs) are expensive, dependent on Synacthen availability, and need supervision. To reduce SST testing, we examined the utility of pre-test cortisol (Cort0) and related parameters in predicting outcome. Design and Measurements: We retrospectively examined the following in all SSTs; (i) Cort0 (ii) indications (iii) and time and place of testing. Receiver operated characteristic (ROC) curves were devised for Cort0 to obtain the best cut-off for outcome prediction in those who had SSTs between 8 and 10 am (Group 1) and at other times (Group 2). Results: Of 506 SSTs, 13 were unsuitable for analysis. 111/493 SSTs (22.5%) were abnormal. (1) ROC curves predicted – (a) SST failure with 100% specificity when Cort0 was ⩽124 nmol/L (Group 1), or ⩽47 (Group 2); (b) a normal SST with 100% sensitivity when Cort0 ⩾314 nmol/L (Group 1) and ⩾323 nmol/L (Group 2). (2) There was significant correlation between Cort0 and 30-minute cortisol ( rs = 0.65-0.78, P < .001). (3) Median Cort0 was lower in those who failed SSTs compared to those who passed (147 vs 298 nmol/L respectively, P < .001). (4) SST failure was commoner in Group 1 vs 2 ( P = .001). (5) There was no difference in outcome between out-patient and inpatient SSTs. (6) SST failure was most common for ‘steroid related’ indications (39.6%, P < .001). Conclusions: This study indicates that (1) Cort0 ⩾ 323 (Group1) and ⩾314 nmol/L (Group 2) predicted a normal SST with 100% sensitivity; (2) Using these cut offs 141/493 (28.6%) tests may have been avoided; (3) supporting evidence should be considered in those with a lower pre-test predictability of failure.

show abstract

Section: Discussionmentioning

confidence: 97%

“… 1 , 2 The validity of SSTs is thought to be unaffected by the time or circumstances of its performance. 3 Its clinical utility is therefore excellent. However, its usefulness is limited by its expense, its intermittent unavailability, 4 the need for clinical supervision, and the inconvenience to patients of having to attend hospital.…”

Section: Introductionmentioning

confidence: 99%

Pre-test Cortisol Levels in Predicting Short Synacthen Test Outcome: A Retrospective Analysis

Ravindran

Carter

Kumar

et al. 2022

Clin Med Insights Endocrinol Diabetes

View full text Add to dashboard Cite

show abstract

“…Additional blood samples for serum cortisol levels were collected at 30 min and 60 min after ACTH administration. The peak cortisol value after ACTH injection of less than 18 μ g/dL (500 nmol/L) was defined as AI [ 11 ]. Among 219 patients on corticosteroid therapy at the time of rapid ACTH stimulation test, 64 patients (29.2%) received prednisolone for 3–4 days a month with a median monthly dose of 75.0 mg (60.0–100.0) and 155 patients (70.8%) received dexamethasone therapy weekly, biweekly, or monthly with a median monthly dose of 37.0 mg (20.0–80.0).…”

Section: Methodsmentioning

confidence: 99%

Prevalence and Risk Factors for Adrenal Insufficiency in Patients with Multiple Myeloma Receiving Long-Term Chemotherapy including Corticosteroids: A Retrospective Cohort Study

Yoon

Ahn

Jung

et al. 2021

BioMed Research International

View full text Add to dashboard Cite

Multiple myeloma (MM) is the second most common hematologic malignancy and requires long-term and high-dose corticosteroid-based chemotherapy. The aim of this study was to investigate the prevalence and clinical predictors of corticosteroid-associated adrenal insufficiency (AI) in patients with MM receiving long-term chemotherapy. This retrospective study included patients with MM who were administered corticosteroid-based chemotherapy and underwent a rapid adrenocorticotropic hormone (ACTH) stimulation test between 2005 and 2018. AI was determined by a peak cortisol value < 18 μg/dL after ACTH stimulation. Demographic, clinical, and laboratory parameters were evaluated, and the prevalence and clinical risk factors of AI were examined. Of 282 patients with MM who received corticosteroid-based chemotherapy, 142 patients (50.4%) were classified as having AI. There were no differences in age, sex, body mass index, comorbidities, and laboratory findings, including serum sodium levels between the AI and no-AI groups. In univariate analysis, the cumulative dose of corticosteroid ( odds ratio OR = 0.99 , 95% confidence interval (CI) 0.98–0.99; P = 0.020 ) and megestrol acetate use ( OR = 2.63 , 95% CI 1.48–4.67; P = 0.001 ) were associated with the occurrence of AI. Cumulative duration and cumulative dose per duration of corticosteroid use were not associated with the occurrence of AI. However, in the multivariate analysis, only megestrol acetate use was associated with an increased risk of AI ( OR = 2.54 , 95% CI 1.41–4.60; P = 0.002 ). Approximately 95.8% of patients with AI had suspicious symptoms or signs of AI. Although clinical symptoms and signs are usually nonspecific, symptomatic patients with MM receiving long-term corticosteroid therapy have sufficient potential for developing AI, particularly when receiving megestrol acetate. These findings can help alert clinicians to consider adrenal suppression following corticosteroid-based chemotherapy in patients with MM.

show abstract

“…In order for the ACTH stimulation test to be significant, at least 60 min. cortisol level should be measured (12).…”

Section: Cortisol Peak Response In Acth Stimulation Testmentioning

confidence: 99%

ACTH Uyarı Testinde Kortizol Pik Yanıtı Zamanının Belirlenmesi

Alagüney¹,

Buyruk²,

Akalın³

et al. 2020

Osmangazi̇ Journal of Medicine

View full text Add to dashboard Cite

Adrenocorticotropic hormone (ACTH) stimulation test is widely used in diagnosis of adrenal insufficiency. Synthetic ACTH analogue has two formulations: Short-acting intravenous or intramuscular form and intramuscular depot form. In the standard ACTH stimulation test protocol, 250μg synthetic ACTH (1-24) is administered intravenously. Blood samples are then taken at 0, 30, 60 and 90 minutes for cortisol. We aimed to determine the time of cortisol peak response by evaluating cortisol responses to intramuscular depot ACTH. Seventy patients who underwent ACTH stimulation test between October 2017 and February 2019 in Eskişehir Osmangazi University Endocrinology Department were included to the study. 250 mcg intramuscular depot ACTH was administered between 08.00-09.00 a.m. Blood samples were taken before ACTH administration and at 30, 60, 120, 240 minutes. Cortisol levels 18 mcg/dl and above was accepted as normal response. Since 20 mcg / dl and above are accepted as normal response in different publications, evaluation was also made on this value. The highest cortisol level was reached in 240 minutes in all patients. If normal cortisol response is accepted as 20 mcg/dl and above, 38 patients reached normal cortisol values at 30th minute, 12 patients at 60th minute, 6 patients at 120th minute. If normal cortisol response is accepted as 18 mcg/dl and above, 38 patients reached normal cortisol values at 30th minute, 10 patients reached normal cortisol values at 60th minute, 2 patients reached 120th minute. In both groups, only one patient was able to reach the target cortisol value after prolongation to 240 minutes. We suggest that prolongation of the stimulation test with intramuscular depot ACTH up to 120 minutes may prevent patients from being misdiagnosed with adrenal insufficiency, but prolongation to 240 minutes will not provide additional benefit.

show abstract

The effect of time of day testing and utility of 30 and 60 minute cortisol values in the 250 mcg ACTH stimulation test

Cited by 18 publications

References 20 publications

Pre-test Cortisol Levels in Predicting Short Synacthen Test Outcome: A Retrospective Analysis

Pre-test Cortisol Levels in Predicting Short Synacthen Test Outcome: A Retrospective Analysis

Prevalence and Risk Factors for Adrenal Insufficiency in Patients with Multiple Myeloma Receiving Long-Term Chemotherapy including Corticosteroids: A Retrospective Cohort Study

ACTH Uyarı Testinde Kortizol Pik Yanıtı Zamanının Belirlenmesi

Contact Info

Product

Resources

About

The effect of time of day testing and utility of 30 and 60 minute cortisol values in the 250 mcg ACTH stimulation test

Cited by 18 publications

References 20 publications

Pre-test Cortisol Levels in Predicting Short Synacthen Test Outcome: A Retrospective Analysis

Pre-test Cortisol Levels in Predicting Short Synacthen Test Outcome: A Retrospective Analysis

Prevalence and Risk Factors for Adrenal Insufficiency in Patients with Multiple Myeloma Receiving Long-Term Chemotherapy including Corticosteroids: A Retrospective Cohort Study

ACTH Uyarı Testinde Kortizol Pik Yanıtı Zamanının Belirlenmesi

Contact Info

Product

Resources

About

The effect of time of day testing and utility of 30 and 60 minute cortisol values in the 250 mcg ACTH stimulation test