The DOI matches its Crossref record; 14 of the 14 references it cites were found in a registry or an index.
Morning Serum Cortisol Level Predicts Central Adrenal Insufficiency Diagnosed by Insulin Tolerance Test
Abstract
Introduction: According to guidelines, a morning serum cortisol level <83 nmol/L is diagnostic for central adrenal insufficiency (CAI), a value >414 nmol/L excludes CAI, while values between 83 and 414 nmol/L require stimulation tests. However, there are no currently reliable data on morning serum cortisol for prediction of cortisol response to insulin tolerance test (ITT). Objective: Using the receiver-operating characteristic curve analysis, the purpose of this study was to detect the morning serum cortisol cutoff with a specificity (SP) or a sensitivity (SE) above 95% that identify those patients who should not be tested with ITT. Methods: We included 141 adult patients (83 males) aged 42.7 ± 12.3 (mean ± standard deviation) years old. Based on the serum cortisol response to ITT, patients have been divided into 2 groups: subjects with CAI (peak serum cortisol <500 nmol/L; 65 patients) and subjects with preserved adrenocortical function (peak cortisol >500 nmol/L; 76 patients). Results: The best morning cortisol cutoff, in terms of SE (87.7%) and SP (46.1%), was ≤323.3 nmol/L. The cutoff of morning serum cortisol concentration that best predicted a deficient response to ITT was ≤126.4 nmol/L (SE 13.8%, SP 98.7%). The cutoff of morning serum cortisol concentration that best predicted a normal response to ITT was >444.7 nmol/L (SE 96.9%, SP 14.5%). Conclusions: This is the first study that identifies a morning serum cortisol cutoff that best predict the response to ITT in order to simplify the diagnostic process in patients with suspected CAI. A new diagnostic flow-chart for CAI is proposed.
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“In this context, the most recent studies stressed the importance of selecting patients to test according to the pretest probability of SAI that should be quantified by evaluating the patients’ clinical background and the morning cortisol levels [14,15].”
From ACTH Stimulation Test for the Diagnosis of Secondary Adrenal Insufficiency: Light and Shadow (2023) · cites this paper as [14]
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Cited by
Opioids and pituitary function: expert opinion
Gadelha, M. R., Karavitaki, N., Fudin, J., Bettinger, J. J., Raff, H., & Ben-Shlomo, A. (2022) · Pituitary · doi:10.1007/s11102-021-01202-y · Cited by 27
ACTH Stimulation Test for the Diagnosis of Secondary Adrenal Insufficiency: Light and Shadow
Birtolo, M. F., Antonini, S., Saladino, A., Zampetti, B., Lavezzi, E., Chiodini, I., Mazziotti, G., Lania, A. G. A., & Cozzi, R. (2023) · Biomedicines · doi:10.3390/biomedicines11030904 · Cited by 19
Metadata
- Authors
- Gasco, V., Bima, C., Geranzani, A., Giannelli, J., Marinelli, L., Bona, C., Cambria, V., Berton, A. M., Prencipe, N., Ghigo, E., Maccario, M., & Grottoli, S.
- Venue
- Neuroendocrinology
- Publisher
- S. Karger AG
- Published
- 2021
- Volume
- 111
- Issue
- 12
- Pages
- 1238-1248
- ISSN
- 0028-3835
- 1423-0194
- Cited by
- 18
- References
- 14
- Language
- en
- Licence
- www.karger.com/Services/SiteLicenses (vor)
- www.karger.com/Services/SiteLicenses (tdm)
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