#PAGE_PARAMS# #ADS_HEAD_SCRIPTS# #MICRODATA#

Diagnostic performance of basal cortisol level at 0900-1300h in adrenal insufficiency


Autoři: Worapaka Manosroi aff001;  Mattabhorn Phimphilai aff001;  Jiraporn Khorana aff002;  Pichitchai Atthakomol aff004
Působiště autorů: Division of Endocrinology, Department of Internal Medicine, Faculty of Medicine, Chiang Mai University Hospital, Chiang Mai, Thailand aff001;  Division of Pediatric Surgery, Department of Surgery, Faculty of Medicine, Chiang Mai University Hospital, Chiang Mai, Thailand aff002;  Clinical Epidemiology and Clinical Statistic Center, Faculty of Medicine, Chiang Mai University Hospital, Chiang Mai, Thailand aff003;  Department of Orthopedics, Faculty of Medicine, Chiang Mai University Hospital, Chiang Mai, Thailand aff004
Vyšlo v časopise: PLoS ONE 14(11)
Kategorie: Research Article
doi: https://doi.org/10.1371/journal.pone.0225255

Souhrn

Objective

An ACTH stimulation test is the standard diagnostic test for adrenal insufficiency (AI). We aimed to investigate the diagnostic performance between serum morning (0800 h) cortisol and serum basal (0900–1300 h) cortisol levels and determine the proper cut-off point to facilitate AI diagnosis to reduce the number of tests.

Methods

A six-year retrospective study was performed in a tertiary care medical center. We identified 416 patients who had undergone either low (LDT) or high dose (HDT) ACTH stimulation outpatient tests. AI was defined as a peak serum cortisol level of <500 nmol/L at 30 or 60 minutes after LDT or HDT. The associations between AI and serum basal and morning cortisol levels were demonstrated by logistic regression model. Diagnostic performance was evaluated by ROC analysis.

Results

Of the 416 patients, 93 (22.4%) were categorized as having AI. The adjusted area under the curve (AUC) for the basal cortisol level for the diagnosis of AI was significantly higher than that for the morning cortisol (0.82 vs 0.69, p <0.001) level. The proposed cut-off values for the basal cortisol were <85 nmol/L (specificity 99.7%) and >350 nmol/L(sensitivity 98.9%). By using these proposed cut-off points, approximately 30% of the ACTH stimulation tests could be eliminated.

Conclusion

The serum basal cortisol level with the proposed cut-off points were considered as an alternative option for diagnosis of AI. Utilizing the serum basal cortisol level can facilitate AI diagnosis as it is convenient, is not a time-specific test and has a high diagnostic performance.

Klíčová slova:

Cortisol – Creatinine – Diagnostic medicine – Cholesterol – Serum albumin – Traditional medicine – Traditional ACTH stimulation test – Low dose ACTH stimulation test


Zdroje

1. Charmandari E, Nicolaides NC, Chrousos GP. Adrenal insufficiency. Lancet. 2014;383(9935):2152–67. Epub 2014/02/08. doi: 10.1016/S0140-6736(13)61684-0 24503135.

2. Reimondo G, Bovio S, Allasino B, Terzolo M, Angeli A. Secondary hypoadrenalism. Pituitary. 2008;11(2):147–54. Epub 2008/04/18. doi: 10.1007/s11102-008-0108-4 18418713.

3. Bornstein SR, Allolio B, Arlt W, Barthel A, Don-Wauchope A, Hammer GD, et al. Diagnosis and Treatment of Primary Adrenal Insufficiency: An Endocrine Society Clinical Practice Guideline. The Journal of clinical endocrinology and metabolism. 2016;101(2):364–89. Epub 2016/01/14. doi: 10.1210/jc.2015-1710 26760044

4. Widmer IE, Puder JJ, Konig C, Pargger H, Zerkowski HR, Girard J, et al. Cortisol response in relation to the severity of stress and illness. J Clin Endocrinol Metab. 2005;90(8):4579–86. Epub 2005/05/12. doi: 10.1210/jc.2005-0354 15886236.

5. Hurel SJ, Thompson CJ, Watson MJ, Harris MM, Baylis PH, Kendall-Taylor P. The short Synacthen and insulin stress tests in the assessment of the hypothalamic-pituitary-adrenal axis. Clinical endocrinology. 1996;44(2):141–6. Epub 1996/02/01. doi: 10.1046/j.1365-2265.1996.555381.x 8849566.

6. Daidoh H, Morita H, Mune T, Murayama M, Hanafusa J, Ni H, et al. Responses of plasma adrenocortical steroids to low dose ACTH in normal subjects. Clinical endocrinology. 1995;43(3):311–5. Epub 1995/09/01. doi: 10.1111/j.1365-2265.1995.tb02037.x 7586600.

7. Dickstein G, Shechner C, Nicholson WE, Rosner I, Shen-Orr Z, Adawi F, et al. Adrenocorticotropin stimulation test: effects of basal cortisol level, time of day, and suggested new sensitive low dose test. The Journal of clinical endocrinology and metabolism. 1991;72(4):773–8. Epub 1991/04/01. doi: 10.1210/jcem-72-4-773 2005201.

8. Le Roux CW, Meeran K, Alaghband-Zadeh J. Is a 0900-h serum cortisol useful prior to a short synacthen test in outpatient assessment? Annals of clinical biochemistry. 2002;39(Pt 2):148–50. Epub 2002/04/05. doi: 10.1258/0004563021901919 11930947.

9. Perton FT, Mijnhout GS, Kollen BJ, Rondeel JM, Franken AA, Groeneveld PH. Validation of the 1 mug short synacthen test: an assessment of morning cortisol cut-off values and other predictors. The Netherlands journal of medicine. 2017;75(1):14–20. Epub 2017/01/27. 28124663.

10. Struja T, Briner L, Meier A, Kutz A, Mundwiler E, Huber A, et al. DIAGNOSTIC ACCURACY OF BASAL CORTISOL LEVEL TO PREDICT ADRENAL INSUFFICIENCY IN COSYNTROPIN TESTING: RESULTS FROM AN OBSERVATIONAL COHORT STUDY WITH 804 PATIENTS. Endocrine practice: official journal of the American College of Endocrinology and the American Association of Clinical Endocrinologists. 2017;23(8):949–61. Epub 2017/06/15. doi: 10.4158/ep171861.Or 28614010.

11. Kline GA, Buse J, Krause RD. Clinical implications for biochemical diagnostic thresholds of adrenal sufficiency using a highly specific cortisol immunoassay. Clinical biochemistry. 2017;50(9):475–80. Epub 2017/02/14. doi: 10.1016/j.clinbiochem.2017.02.008 28192125.

12. Javorsky B, Carroll T, Algeciras-Schimnich A, Singh R, Colon-Franco J, Findling J. SAT-390 New Cortisol Threshold for Diagnosis of Adrenal Insufficiency After Cosyntropin Stimulation Testing Using the Elecsys Cortisol II, Access Cortisol, and LC-MS/MS Assays. Journal of the Endocrine Society. 2019;3(Suppl 1):SAT–390. doi: 10.1210/js.2019-SAT-390

13. Bacon GE, Kenny FM, Murdaugh HV, Richards C. Prolonged serum half-life of cortisol in renal failure. The Johns Hopkins medical journal. 1973;132(2):127–31. Epub 1973/02/01. 4684170.

14. Raff H, Trivedi H. Circadian rhythm of salivary cortisol, plasma cortisol, and plasma ACTH in end-stage renal disease. Endocr Connect. 2013;2(1):23–31. Epub 2013/06/20. doi: 10.1530/EC-12-0058 23781315

15. Verbeeten KC, Ahmet AH. The role of corticosteroid-binding globulin in the evaluation of adrenal insufficiency. Journal of pediatric endocrinology & metabolism: JPEM. 2018;31(2):107–15. Epub 2017/12/02. doi: 10.1515/jpem-2017-0270 29194043.

16. Dorin RI, Qualls CR, Crapo LM. Diagnosis of adrenal insufficiency. Annals of internal medicine. 2003;139(3):194–204. Epub 2003/08/06. doi: 10.7326/0003-4819-139-3-200308050-00009 12899587.

17. Pura M, Kreze A Jr., Kentos P, Vanuga P. The low-dose (1 microg) cosyntropin test (LDT) for primary adrenocortical insufficiency: Defining the normal cortisol response and report on first patients with Addison disease confirmed with LDT. Experimental and clinical endocrinology & diabetes: official journal, German Society of Endocrinology [and] German Diabetes Association. 2010;118(3):151–7. Epub 2009/04/10. doi: 10.1055/s-0029-1202275 19358090.

18. Fleseriu M, Gassner M, Yedinak C, Chicea L, Delashaw JB Jr., Loriaux DL. Normal hypothalamic-pituitary-adrenal axis by high-dose cosyntropin testing in patients with abnormal response to low-dose cosyntropin stimulation: a retrospective review. Endocrine practice: official journal of the American College of Endocrinology and the American Association of Clinical Endocrinologists. 2010;16(1):64–70. Epub 2009/10/17. doi: 10.4158/ep09153.Or 19833587.

19. Ospina NS, Al Nofal A, Bancos I, Javed A, Benkhadra K, Kapoor E, et al. ACTH Stimulation Tests for the Diagnosis of Adrenal Insufficiency: Systematic Review and Meta-Analysis. The Journal of clinical endocrinology and metabolism. 2016;101(2):427–34. Epub 2015/12/10. doi: 10.1210/jc.2015-1700 26649617.

20. Mackenzie SD, Gifford RM, Boyle LD, Crane MS, Strachan MWJ, Gibb FW. Validated criteria for the interpretation of a single measurement of serum cortisol in the investigation of suspected adrenal insufficiency. Clinical endocrinology. 2019. Epub 2019/08/06. doi: 10.1111/cen.14071 31380575.


Článek vyšel v časopise

PLOS One


2019 Číslo 11
Nejčtenější tento týden
Nejčtenější v tomto čísle
Kurzy

Zvyšte si kvalifikaci online z pohodlí domova

plice
INSIGHTS from European Respiratory Congress
nový kurz

Současné pohledy na riziko v parodontologii
Autoři: MUDr. Ladislav Korábek, CSc., MBA

Svět praktické medicíny 3/2024 (znalostní test z časopisu)

Kardiologické projevy hypereozinofilií
Autoři: prof. MUDr. Petr Němec, Ph.D.

Střevní příprava před kolonoskopií
Autoři: MUDr. Klára Kmochová, Ph.D.

Všechny kurzy
Kurzy Podcasty Doporučená témata Časopisy
Přihlášení
Zapomenuté heslo

Zadejte e-mailovou adresu, se kterou jste vytvářel(a) účet, budou Vám na ni zaslány informace k nastavení nového hesla.

Přihlášení

Nemáte účet?  Registrujte se

#ADS_BOTTOM_SCRIPTS#