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Baseline morning cortisol level as a predictor of pituitary–adrenal reserve: a comparison across three assays
Author(s) -
Sbardella Emilia,
Isidori Andrea M.,
Woods Conor P.,
Argese Nicola,
Tomlinson Jeremy W.,
Shine Brian,
JafarMohammadi Bahram,
Grossman Ashley B.
Publication year - 2017
Publication title -
clinical endocrinology
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 1.055
H-Index - 147
eISSN - 1365-2265
pISSN - 0300-0664
DOI - 10.1111/cen.13232
Subject(s) - morning , medicine , roche diagnostics , endocrinology , receiver operating characteristic , context (archaeology) , adrenal function , adrenocorticotropic hormone , area under the curve , biology , hormone , paleontology
Summary Context The short ACTH stimulation test (250 μg) is the dynamic test most frequently used to assess adrenal function. It is possible that a single basal cortisol could be used to predict the dynamic response, but research has been hampered by the use of different assays and thresholds. Objective To propose a morning baseline cortisol criterion of three of the most commonly used modern cortisol immunoassays – Advia Centaur (Siemens), Architect (Abbott) and the Roche Modular System (Roche) – that could predict adrenal sufficiency. Design Observational, retrospective cross‐sectional study at two centres. Patients and Measurements Retrospective analysis of the results of 1019 Short Synacthen tests (SSTs) with the Advia Centaur, 449 SST s with the Architect and 2050 SST s with the Roche Modular System assay . Serum cortisol levels were measured prior to injection of 250 μg Synacthen and after 30 min. Overall, we were able to collate data from a total of 3518 SST s in 3571 patients. Results Using receiver–operator curve analysis, baseline cortisol levels for predicting passing the SST with 100% specificity were 358 nmol/l for Siemens , 336 nmol/l for Abbott and 506 nmol/l for Roche . Utilizing these criteria, 589, 158 and 578 SST s, respectively, for Siemens, Abbott and Roche immunoassays could have been avoided. Conclusions We have defined assay‐specific morning cortisol levels that are able to predict the integrity of the hypothalamo–pituitary–adrenal axis. We propose that this represents a valid tool for the initial assessment of adrenal function and has the potential to obviate the need for dynamic testing in a significant number of patients.