{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2025,11,18]],"date-time":"2025-11-18T04:00:22Z","timestamp":1763438422536,"version":"3.45.0"},"reference-count":41,"publisher":"Oxford University Press (OUP)","issue":"5","license":[{"start":{"date-parts":[[2025,10,15]],"date-time":"2025-10-15T00:00:00Z","timestamp":1760486400000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":[],"published-print":{"date-parts":[[2025,10,30]]},"abstract":"<jats:title>Abstract<\/jats:title>\n                  <jats:sec>\n                    <jats:title>Design<\/jats:title>\n                    <jats:p>Morning cortisol predicts the outcome of the short synacthen test (SST). There is a paucity of studies examining this in a dedicated cohort of children and adults weaning off glucocorticoids and using a modern immunoassay. This study aimed to identify early morning serum cortisol (EMC) cut-offs which predict the SST outcome in children and adults during glucocorticoid weaning.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods<\/jats:title>\n                    <jats:p>A retrospective cohort study of pediatric and adult patients on long-term glucocorticoids with suspected glucocorticoid-induced adrenal insufficiency (GIAI) undergoing an SST. Our main outcomes were cut offs with 95% and 99% sensitivity and specificity for EMC analysed on modern immunoassays, determined via receiver operating characteristic (ROC) curve analysis. A pass on SST was defined as 30-min cortisol of \u2265430\u2005nmol\/L (15.6\u2005\u00b5g\/dL).<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>151 and 372 SSTs were included in the pediatric and adult cohorts, respectively, of which 32% and 37% were passed. ROC curve analysis demonstrated that EMC performed well in both cohorts with area under curve (AUC) of 0.79 (95% CI, 0.71, 0.87) and 0.88 (95% CI, 0.84, 0.91), respectively. EMC cut offs to predict a pass on SST were 278 (10.1\u2005\u00b5g\/dL) and 290\u2005nmol\/L (10.5\u2005\u00b5g\/dL) at 95% sensitivity, and 316 (11.5\u2005\u00b5g\/dL) and 349\u2005nmol\/L (12.7\u2005\u00b5g\/dL) at 99% sensitivity, respectively. Further analysis in adults showed that using a 95% cut off in clinical practice was effective as 48\/51 patients with EMC between 290 and 349\u2005nmol\/L (10.5-12.7\u2005\u00b5g\/dL), were weaned off without adverse events.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusion<\/jats:title>\n                    <jats:p>Morning serum cortisol can predict the SST outcome in children and adults weaning from glucocorticoids. An EMC &amp;gt; 290\u2005nmol\/L in adults predicts a patient can stop glucocorticoid therapy and will recover adrenal function.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1093\/ejendo\/lvaf215","type":"journal-article","created":{"date-parts":[[2025,10,14]],"date-time":"2025-10-14T12:20:59Z","timestamp":1760444459000},"page":"554-562","source":"Crossref","is-referenced-by-count":0,"title":["Diagnostic performance of morning serum cortisol for glucocorticoid weaning in children and adults"],"prefix":"10.1093","volume":"193","author":[{"ORCID":"https:\/\/orcid.org\/0000-0001-9932-0941","authenticated-orcid":false,"given":"Muhammad Fahad","family":"Arshad","sequence":"first","affiliation":[{"name":"Division of Clinical Medicine, School of Medicine and Population Health, University of Sheffield , Sheffield S10 2RX ,","place":["United Kingdom"]},{"name":"Department of Endocrinology & Diabetes, Sheffield Teaching Hospitals NHS Foundation Trust , Sheffield S10 2JF 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