Eng Pei Chia, Ramadoss Vijay, Tan Li Ying Lyeann, Ong Li Zhen, Deepak Doddabele Srinivasa, Khoo Chin Meng
Department of Medicine, National University of Singapore, Singapore, Singapore; Division of Endocrinology, Department of Medicine, National University Hospital, Singapore, Singapore.
Ministry of Health Holdings, Singapore, Singapore.
Endocr Pract. 2025 Jan;31(1):34-41. doi: 10.1016/j.eprac.2024.10.006. Epub 2024 Oct 18.
No studies have investigated the predictors of an adequate cortisol response to the short synacthen test (SST) and the appropriateness of patient selection for SST in the Southeast Asian population. The aim of our study is to investigate the predictors and indications of SSTs and concondance of SSTs conducted with outcomes.
This is a retrospective study investigating all SSTs performed over a year in a tertiary center. Clinical data of patients with SSTs between February 2022 and February 2023 were extracted. We determined the appropriateness of SST testing. Binary logistic regression was used to assess the parameters that predict adequate cortisol response on SST. The proportion of individuals with biochemical "pass" or "fail" on SST was compared with the Χ test. Baseline cortisol levels that predicted SST pass were determined using area under receiving operating characteristics curves.
Of the 781 SSTs, 83.9% of SSTs showed an adequate cortisol response. Postural hypotension (26.9%) and exogenous glucocorticoid administration (14.2%) were common indications for SST. In our cohort, 50.2% of the SSTs were inappropriately indicated. Pretest serum cortisol and albumin predict biochemical pass on SST. A pretest cortisol level of 300 nmol/L predicted SST response with 93% sensitivity and a cortisol level of <100 nmol/L confirmed adrenal insufficiency (AI) with 97.3% specificity. Using these cortisol thresholds could avoid 302 (38.5%) of SSTs.
Our analysis showed that clinical features of AI do not reliably predict SST outcomes. We advocate careful assessment of the pretest probability of AI in patients referred for SST. A pretest cortisol level can reduce the number of SSTs, with cost savings implications.
尚无研究调查东南亚人群中促肾上腺皮质激素短试验（SST）皮质醇反应充分的预测因素以及SST患者选择的合理性。我们研究的目的是调查SST的预测因素和适应症以及SST结果与实际情况的一致性。
这是一项回顾性研究，调查了一家三级中心一年内进行的所有SST。提取了2022年2月至2023年2月期间接受SST患者的临床数据。我们确定了SST检测的合理性。采用二元逻辑回归评估预测SST皮质醇反应充分的参数。使用χ检验比较SST生化“通过”或“未通过”个体的比例。利用接受操作特征曲线下面积确定预测SST通过的基线皮质醇水平。
在781次SST中，83.9%的SST显示皮质醇反应充分。体位性低血压（26.9%）和外源性糖皮质激素使用（14.2%）是SST的常见适应症。在我们的队列中，50.2%的SST适应症不合适。检测前血清皮质醇和白蛋白可预测SST生化通过情况。检测前皮质醇水平为300 nmol/L时预测SST反应的敏感性为93%，皮质醇水平<100 nmol/L时确诊肾上腺皮质功能不全（AI）的特异性为97.3%。使用这些皮质醇阈值可避免302次（38.5%）SST。
我们的分析表明，AI的临床特征不能可靠地预测SST结果。我们主张对转诊接受SST的患者仔细评估AI的检测前概率。检测前皮质醇水平可减少SST次数，具有节约成本的意义。
