Spot and Morning Cortisol in Comparison to Low Dose Short Synacthen®Test

Authors

  • Kitty Kit-Ting Cheung Division of Endocrinology and Diabetes Department of Medicine and Therapeutics Prince of Wales Hospital The Chinese University of Hong Kong
  • Wing-Yee So Division of Endocrinology and Diabetes Department of Medicine and Therapeutics Prince of Wales Hospital The Chinese University of Hong Kong
  • Ronald Ma Division of Endocrinology and Diabetes Department of Medicine and Therapeutics Prince of Wales Hospital The Chinese University of Hong Kong
  • Alice Kong Division of Endocrinology and Diabetes Department of Medicine and Therapeutics Prince of Wales Hospital The Chinese University of Hong Kong
  • Francis Chun-Chung Chow Division of Endocrinology and Diabetes Department of Medicine and Therapeutics Prince of Wales Hospital The Chinese University of Hong Kong

Keywords:

spot cortisol, morning cortisol, adrenal insufficiency, low dose short Synacthen® test

Abstract

Objective.  While the low dose short Synacthen® test (LDSST) is considered to be the gold standard to evaluate adrenal function, it is labor-intensive, invasive and inconvenient.   The aim of the study is to identify cut-offs for spot serum cortisol for in-patients and morning serum cortisol for out-patients. The study also aims to describe the disease spectrum leading to suspicion of adrenal insufficiency in a Chinese out-patient cohort.    

Methodology.  Adult patients were recruited from a tertiary hospital in Hong Kong.  423 in-patients were included consecutively from July 2013 to December 2013, and 422 out-patients from June 2014 to October 2014.  Serum cortisol responses at 0, 20 and 30 minutes were evaluated.     

Results.  For in-patients admitted for acute illness, a spot serum cortisol of ≤92 nmol/L indicated adrenal insufficiency, and a value of ≥494 nmol/L signaled adequate adrenal reserve.  The respective morning cortisol values for out-patients who were ambulatory and not under stress were ≤124 nmol/L and ≥428 nmol/L.  The percentage of unnecessary LDSST was higher in the in-patient cohort than the out-patient cohort (43% and 37%, respectively).  The most common referral for out-patient LDSST was for suspected iatrogenic Cushing’s syndrome (ie:  iatrogenic adrenal suppression) from Rheumatology.

Conclusions. The LDSST is of little added value in in-patients with spot serum cortisol of ≤92 nmol/L or ≥494 nmol/L and out-patients with morning serum cortisol of ≤124 nmol/L or ≥428 nmol/L.  Spot and morning cortisol levels, for in and out-patients respectively, should be incorporated into endocrine protocols preceding the LDSST in the workup of adrenal insufficiency

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Author Biography

Kitty Kit-Ting Cheung, Division of Endocrinology and Diabetes Department of Medicine and Therapeutics Prince of Wales Hospital The Chinese University of Hong Kong

Resident Specialist and Honoary Clinical Assistant Professor

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Published

2015-11-30

How to Cite

Cheung, K. K.-T., So, W.-Y., Ma, R., Kong, A., & Chow, F. C.-C. (2015). Spot and Morning Cortisol in Comparison to Low Dose Short Synacthen®Test. Journal of the ASEAN Federation of Endocrine Societies, 30(2), 147. Retrieved from https://www.asean-endocrinejournal.org/index.php/JAFES/article/view/240

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Original Articles