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The short synacthen test: Variations in methodology and protocols in KSA.
Muhammad I Butt1, Nouf Alzuhayri2, Muhammad Riazuddin1
1King Faisal Specialist Hospital & Research Centre, Department of Medicine, Riyadh, KSA.
Journal of Taibah University Medical Sciences
|August 19, 2022
Summary
The short synacthen test (SST) is often normal, and including a 60-minute cortisol measurement helps avoid false positives. Consider other causes for metabolic issues before ordering an SST.
Area of Science:
- Endocrinology
- Clinical Practice
Background:
- The short synacthen test (SST) is a diagnostic tool used to assess adrenal function.
- Variations in SST protocols may exist across different clinical settings.
Purpose of the Study:
- To compare current Kingdom-wide SST practices with prior institutional findings.
- To determine if physician specialty or grade influences SST protocol selection.
Main Methods:
- A survey was distributed to clinicians registered with the Saudi Medical Council.
- Clinicians were queried about their SST protocols and reasons for test performance.
Main Results:
- 162 responses were received, primarily from endocrinologists and internists of varying grades.
- Common indications for SST include hypotension, hyponatremia, hypoglycemia, and hyperkalemia.
- Most clinicians measure baseline cortisol and ACTH, with 75% measuring cortisol at both 30 and 60 minutes post-ACTH injection.
- A stimulated cortisol level of 550 nmol/L was widely considered the threshold for normal adrenal function, and 90% of SSTs performed were normal.
Conclusions:
- The 60-minute serum cortisol measurement is crucial in the SST protocol to prevent false-positive results.
- Clinicians should investigate alternative causes for metabolic derangements before ordering an SST, especially in patients with low pretest probability.
