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A systematic review and meta-analysis of Synacthen tests for assessing hypothalamic-pituitary-adrenal insufficiency

Sze May Ng1, Juliana Chizo Agwu2, Kerry Dwan3

  • 1Department of Paediatrics, Southport and Ormskirk NHS Trust, Ormskirk, UK Institute of Translational Medicine, University of Liverpool, Liverpool, UK.

Archives of Disease in Childhood
|March 9, 2016
PubMed

Insights

The short Synacthen test (SST) shows higher specificity than the low-dose Synacthen test (LDSST) for diagnosing hypothalamic-pituitary-adrenal axis insufficiency in children. Neither test is clearly superior, and individualized clinical judgment is recommended.

Area of Science:

  • Pediatric Endocrinology
  • Diagnostic Test Evaluation
  • Hormone Axis Assessment

Background:

  • The diagnostic accuracy of tests for hypothalamic-pituitary-adrenal (HPA) axis insufficiency in children is debated.
  • Standardized protocols for HPA axis testing in pediatric populations are lacking.

Purpose of the Study:

  • To systematically review and meta-analyze the diagnostic value of the short Synacthen test (SST) and low-dose Synacthen test (LDSST) for HPA axis insufficiency in children.
  • To compare the diagnostic performance of SST and LDSST.

Main Methods:

  • Systematic review and meta-analysis with receiver-operating characteristic curve analysis.
  • Inclusion of studies comparing SST and/or LDSST against a reference standard for central adrenal insufficiency in children.
  • Assessment of diagnostic values including sensitivity, specificity, and likelihood ratios.

Main Results:

  • No randomized trials were identified.
  • The SST demonstrated higher specificity (99% vs. 88%) and positive likelihood ratio compared to the LDSST.
  • The LDSST showed higher sensitivity (86% vs. 61%) but with significant heterogeneity due to varying Synacthen doses.

Conclusions:

  • Lack of standardized assays and protocols contributes to diagnostic inaccuracies in HPA axis assessment.
  • There is insufficient evidence to support the superiority of LDSST over SST in pediatric HPA axis evaluation.
  • Individualized clinical judgment should guide the choice between SST and LDSST, highlighting the need for a robust, randomized controlled trial.
Abstract

Keywords:
ACTHadrenalcortisolcosyntropinsynacthen

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