Biochemistry Department, University Hospitals Coventry & Warwickshire NHS Trust, Coventry, UK.
Ann Clin Biochem. 2010 Mar;47(Pt 2):158-64. doi: 10.1258/acb.2009.009209. Epub 2010 Feb 11.
We present the first national audit of the Short Synacthen Test (SST), identifying the clinical, analytical and interpretative procedures adopted by 89 laboratories.
The SST has replaced the insulin stress test as the first-line test to assess adrenal insufficiency and has received considerable attention regarding its sensitivity and specificity. Concerns regarding this test include the bias of cortisol methods, cut-off values used, contraindications and the limitations of the test in diagnosing recent, mild secondary adrenal insufficiency. The audit took into consideration the protocols used by laboratories, the advice provided prior and after the SST and the analytical bias of the methods used.
A web-based questionnaire using Microsoft FrontPage(TM) was prepared to collect data from laboratories and provided drop-down lists and other form-field elements to capture additional comments. The resultant data were exported to Microsoft Excel(TM) for data clean-up and analysis.
The workloads were highly variable; however, most laboratories were in general agreement to the indications, contraindications, timing and reference ranges. In contrast, there was variability in the bias of the cortisol methods, which had not been translated to the cut-off values used by the majority of laboratories.
The audit has shown that though the preanalytical procedures were similar in most laboratories, there is a requirement to recognize the effect that method bias may have on the reference ranges and consequently on the diagnosis of adrenal insufficiency. There is a need to develop consensus guidelines, which can aid both clinicians and laboratories.
我们呈现了第一次全国性的短 Synacthen 测试（SST）的审计，确定了 89 个实验室采用的临床、分析和解释程序。
SST 已取代胰岛素应激测试，成为评估肾上腺功能不全的一线测试，其敏感性和特异性受到了广泛关注。人们对这项测试的关注包括皮质醇方法的偏差、使用的截止值、禁忌症以及该测试在诊断近期轻度继发性肾上腺功能不全方面的局限性。此次审计考虑了实验室使用的方案、SST 前后提供的建议以及所使用方法的分析偏差。
使用 Microsoft FrontPage(TM) 制作了一个基于网络的问卷，从实验室收集数据，并提供了下拉列表和其他表单字段元素以捕获其他评论。所得数据被导出到 Microsoft Excel(TM) 进行数据清理和分析。
工作量差异很大；然而，大多数实验室对适应证、禁忌证、时机和参考范围基本达成一致。相比之下，皮质醇方法的偏差存在差异，而大多数实验室使用的截止值并未转化为这些偏差。
此次审计表明，尽管大多数实验室的预分析程序相似，但需要认识到方法偏差可能对参考范围，进而对肾上腺功能不全的诊断产生的影响。需要制定共识指南，以帮助临床医生和实验室。
