%0 Journal Article
%T Utility of the low-dose short Synacthen test in diagnosis of adrenal insufficiency in outpatients with nonspecific symptoms
%A Anne Corbould
%A Matthew Jarvis
%A Joanne Campbell
%A Deborah Kunde
%J Endocrinology Studies
%D 2012
%I PAGEPress Publications
%R 10.4081/es.2012.e5
%X Short Synacthen tests are used to diagnose primary and secondary adrenal insufficiency. The standard test uses supraphysiological adrenocorticotropic hormone (250 ¦Ìg). The low-dose test (1 ¦Ìg) was proposed to be more sensitive. In outpatients with nonspecific symptoms referred for exclusion of adrenal insufficiency, we assessed whether the low-dose test was an appropriate initial investigation. Results of 233 low-dose tests were obtained from pathology database 2007-2009. Clinical data were available for 169 patients: 37 taking glucocorticoids or with known pituitary/adrenal disease were excluded. Among the remaining 132 patients, 26% failed using stimulated cortisol ¡Ý500 nmol/L and 45% failed at ¡Ý550 nmol/L. These rates of apparent adrenal insufficiency are ~50 fold above expected. In conclusion, the low-dose test, using conventional criteria for normality, is abnormal in a large proportion of patients with nonspecific symptoms. Until criteria for normal cortisol response to low-dose Synacthen are clarified, alternative tests of adrenal function are advised in this clinical setting.
%K adrenal insufficiency/diagnosis
%K cosyntropin/diagnostic use
%K humans
%K outpatients
%U http://www.pagepress.org/journals/index.php/es/article/view/4512