The performance of serum cortisol, plasma corticotropin and serum dehydroepiandrosterone sulfate levels in the diagnosis of hypothalamic pituitary adrenal dysfunction

Abstract

Background: There is no single test can identify hypothalamic-pituitary-adrenal dysfunction (HPAD) perfectly. The study aimed to assess the performance of measuring serum cortisol, serum dehydroepiandrosterone sulfate (DHEA-S) and plasma corticotropin (ACTH) in comparison with standard-dose short cosyntropin (250 µg) testing for the diagnosis of HPAD.Methods: This is a cross-sectional study from Al-Faiha Specialized Diabetes, Endocrine, and Metabolism Center (FDEMC) in Basrah for the period of November 2014 to October 2015. For all patients with suspected HPAD; baseline serum cortisol, serum DHEA-S and plasma ACTH and were measured, followed by a formal short cosyntropin test as the gold standard test. Results:The total number of the study participant was 169 patients.Of them, 134 (79.3%) were women. Their age ranges from 5-80 years. The cut-off serum cortisol that predicts abnormal short cosyntropin test was less than 5.31 µg/dl with maximal sensitivity and specificity of 87.7% and 90.4% respectively. The cut-off serum DHEA-S that predict abnormal short cosyntropin test was less than 31.11 µg/dl with a sensitivity of 89.2%and specificity of 62.7%. The least reliable parameter to predict the abnormal short cosyntropin was the plasma ACTH level with a cut-off of less than 5.30 pg/ml and lowest sensitivity of 68.8% and specificity of 74.5%. Conclusion:To exclude HPAD, serum cortisol at 9-11 am having the highest predictive value, DHEA-S has the midway function and plasma