门诊内分泌科中使用基础皮质醇水平预测1μg促肾上腺皮质激素试验的结果。
The use of baseline cortisol level in predicting the outcome of 1 μg Synacthen tests in an outpatient endocrinology unit.
作者信息
Lassoued Najoua, Zantour Baha, Alaya Wafa, Sfar Mohamed Hbib
机构信息
Endocrinology Department, Taher Sfar University Hospital, Mahdia, 5100, Tunisia.
出版信息
Heliyon. 2022 May 30;8(6):e09559. doi: 10.1016/j.heliyon.2022.e09559. eCollection 2022 Jun.
INTRODUCTION
The clinical requirements and the indication of the Synacthen test are increasing. The objective of our study is to determine a baseline cortisol level that reliably predicts the response to Synacthen test in a low-risk group of patients.
MATERIALS AND METHODS
We performed a cross-sectional analysis of all Synacthen tests conducted between January 2017 and June 2018. The diagnostic accuracy of basal cortisol levels as a predictor of an adequate response to Synacthen test was evaluated by ROC curve analysis.
RESULTS
One hundred and fifty-three patients were included. A baseline cortisol level <40 ng/mL had a sensitivity of 100% but a specificity of 5.8% for the failure of the Synacthen test, while a baseline cortisol level> 147.5 ng/mL showed a specificity of 100% but a sensitivity of 1.2% for an adequate response to the Synacthen test. According to the ROC curve, the optimal baseline cortisol level for predicting an adequate response to the Synacthen test was 85 ng/mL with an AUC of 0.808 (95% CI [0.738-0.877]).
CONCLUSION
We propose a basal cortisol level assay as a first step in the evaluation of patients with suspected adrenal insufficiency.
引言
促肾上腺皮质激素（Synacthen）试验的临床需求和适应证不断增加。我们研究的目的是确定一个基线皮质醇水平，该水平能可靠地预测低风险患者群体对促肾上腺皮质激素试验的反应。
材料与方法
我们对2017年1月至2018年6月期间进行的所有促肾上腺皮质激素试验进行了横断面分析。通过ROC曲线分析评估基础皮质醇水平作为促肾上腺皮质激素试验充分反应预测指标的诊断准确性。
结果
共纳入153例患者。对于促肾上腺皮质激素试验失败，基线皮质醇水平<40 ng/mL的敏感性为100%，但特异性为5.8%；而对于促肾上腺皮质激素试验的充分反应，基线皮质醇水平>147.5 ng/mL的特异性为100%，但敏感性为1.2%。根据ROC曲线，预测促肾上腺皮质激素试验充分反应的最佳基线皮质醇水平为85 ng/mL，曲线下面积（AUC）为0.808（95%可信区间[0.738 - 0.877]）。
结论
我们建议将基础皮质醇水平检测作为疑似肾上腺功能不全患者评估的第一步。
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