Butt Muhammad I, Alzuhayri Nouf, Riazuddin Muhammad, Bakhsh Abdulmohsen M K
King Faisal Specialist Hospital & Research Centre, Department of Medicine, Riyadh, KSA.
King Faisal Specialist Hospital & Research Centre, Department of Biostatistics, Riyadh, KSA.
J Taibah Univ Med Sci. 2022 Feb 11;17(4):596-601. doi: 10.1016/j.jtumed.2022.01.010. eCollection 2022 Aug.
This study aimed to compare the current Kingdom-wide practice with our prior institutional study on use of the short synacthen test (SST), and to determine whether physician specialty or grade is associated with a tendency toward using a particular protocol.
We surveyed clinicians registered with the Saudi Medical Council to determine the different SST protocols used within KSA.
We received 162 responses, 66 (41%) from endocrinologists and the remainder from internists. A total of 61 (38%) respondents were consultants, whereas the rest were non-consultant grade. The clinicians indicated metabolic derangements, such as hypotension (78%), hyponatremia (65%), hypoglycemia (59%), and hyperkalemia (54%), as the main reasons for performing the test. Most clinicians used the SST protocol, which measures baseline serum cortisol (90%) and ACTH (78%) on the test day. A total of 75% of the physicians measured both the 30- and 60-minute serum cortisol after ACTH injection. Of these clinicians, 13% reported that the cortisol levels were below the pass threshold at 30 min but reached the pass threshold only at 60 min. The SST was normal 90% of the time when performed. A total of 93% of the clinicians considered a stimulated cortisol level of 550 nmol/L to be the threshold for normal adrenal function.
The survey confirms that 60-min serum cortisol should be part of the SST protocol to avoid false-positive results. Moreover, clinicians should consider other causes of these metabolic derangements before requesting a SST, particularly in patients with a low pretest probability.
本研究旨在比较沙特全国目前使用短效促肾上腺皮质激素试验（SST）的情况与我们之前机构性研究的结果，并确定医生的专业或级别是否与使用特定方案的倾向有关。
我们对在沙特医学委员会注册的临床医生进行了调查，以确定沙特阿拉伯王国境内使用的不同SST方案。
我们收到了162份回复，其中66份（41%）来自内分泌科医生，其余来自内科医生。共有61名（38%）受访者为顾问医生，其余为非顾问级别。临床医生指出代谢紊乱，如低血压（78%）、低钠血症（65%）、低血糖（59%）和高钾血症（54%），是进行该试验的主要原因。大多数临床医生使用在试验当天测量基础血清皮质醇（90%）和促肾上腺皮质激素（78%）的SST方案。共有75%的医生在注射促肾上腺皮质激素后测量了30分钟和60分钟时的血清皮质醇。在这些临床医生中，13%报告说皮质醇水平在30分钟时低于通过阈值，但仅在60分钟时达到通过阈值。进行SST时，90%的情况下结果正常。共有93%的临床医生认为刺激后皮质醇水平达到550 nmol/L是肾上腺功能正常的阈值。
该调查证实，60分钟时的血清皮质醇应作为SST方案的一部分，以避免假阳性结果。此外，临床医生在要求进行SST之前应考虑这些代谢紊乱的其他原因，尤其是在预测试概率较低的患者中。
