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A Pragmatic Approach to Monitor for Adrenal Axis Recovery After a Failed Short Synacthen Test
Anes Harid1, Matthew Rowe2, Nishchil Patel2
1Peninsula Medical School, University of Plymouth, Plymouth, UK.
Summary
A morning cortisol level of 126 nmol/L or lower accurately indicates adrenal axis non-recovery, eliminating the need for further short Synacthen tests (SSTs) in patients with known adrenal insufficiency.
Area of Science:
- Endocrinology
- Clinical Chemistry
Background:
- Adrenal axis insufficiency requires monitoring for recovery.
- The short Synacthen test (SST) is commonly used but can be resource-intensive.
Purpose of the Study:
- To establish a morning cortisol threshold to identify adrenal axis non-recovery.
- To determine if this threshold can obviate the need for SSTs in certain patients.
Main Methods:
- Analysis of 1570 SSTs (952 individuals) over 10 years.
- Quantile regression modeling to predict peak cortisol response and identify a failure threshold.
- Focus on baseline cortisol levels taken before 9:30 am.
Main Results:
- A baseline morning cortisol level of ≤126 nmol/L predicted a ≥95% chance of failing an SST.
- 60% of follow-up SSTs had baseline cortisol below this threshold, and none passed.
Conclusions:
- Early morning cortisol ≤126 nmol/L is a reliable indicator of adrenal axis non-recovery.
- Baseline cortisol measurement can serve as an effective screening tool for adrenal recovery.
- This approach may significantly reduce the number of follow-up SSTs required.
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