{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,6,17]],"date-time":"2026-06-17T21:12:18Z","timestamp":1781730738235,"version":"3.54.5"},"reference-count":21,"publisher":"Wiley","issue":"2","license":[{"start":{"date-parts":[[2023,6,8]],"date-time":"2023-06-08T00:00:00Z","timestamp":1686182400000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/creativecommons.org\/licenses\/by-nc-nd\/4.0\/"}],"content-domain":{"domain":["onlinelibrary.wiley.com"],"crossmark-restriction":true},"short-container-title":["Clinical Endocrinology"],"published-print":{"date-parts":[[2023,8]]},"abstract":"<jats:title>Abstract<\/jats:title><jats:sec><jats:title>Objective<\/jats:title><jats:p>Increasing referrals to Endocrinology with nonspecific symptoms of suspected adrenal insufficiency (AI)\u00a0has increased use of the short\u2010synacthen test (SST). Prevailing resource and safety concerns emphasise importance of patient selection criterion to optimise SST use. This study aimed to (1) document the adverse event profile of the SST (2) identify any pretest predictors of SST outcome.<\/jats:p><\/jats:sec><jats:sec><jats:title>Design, Patients and Measurements<\/jats:title><jats:p>Retrospective data analysis of all patients referred for SST in Oxford from 2017 to 2021. Pretest clinical variables (age, sex, BMI, blood pressure and electrolytes), symptoms (fatigue, dizziness, weight loss) and pretest morning cortisol were included in the statistical model with the aim of identifying any variables that could predict SST outcome in Group 1 primary AI, Group 2 central AI and Group 3 glucocorticoid induced\u00a0AI. Symptoms and signs during and post SST were also noted with the aim of describing adverse effects to synacthen across a large cohort.<\/jats:p><\/jats:sec><jats:sec><jats:title>Results<\/jats:title><jats:p>A total 1480 SSTs (Males:38%, age 52 [39\u221266] years) were performed: 505 (34.1%) in Group 1, 838 (57%) in Group 2, and 137 (9.3%) in Group 3. Adverse\u2010effects were recorded in 1.8% of tests, including one episode of anaphylaxis. Pretest morning\u2010cortisol was the only predictor for an \u201cSST pass\u201d (whole cohort: <jats:italic>B<\/jats:italic>\u2009=\u20090.015, <jats:italic>p<\/jats:italic>\u2009&lt;\u20090.001, Group 1: <jats:italic>B<\/jats:italic>\u2009=\u20090.018, <jats:italic>p<\/jats:italic>\u2009&lt;\u2009.001; Group 2: <jats:italic>B<\/jats:italic>\u2009=\u20090.010, <jats:italic>p<\/jats:italic>\u2009&lt;\u20090.012; Group 3: <jats:italic>B<\/jats:italic>\u2009=\u20090.018, <jats:italic>p<\/jats:italic>\u2009=\u2009&lt;.001). A threshold of \u2265343\u2009nmol\/l (receiver\u2010operating characteristic\u00a0[ROC] area under the curve [AUC]\u2009=\u20090.725, 95% confidence interval [CI] 0.675\u22120.775, <jats:italic>p<\/jats:italic>\u2009&lt;\u20090.001) for the whole cohort, \u2265300\u2009nmol\/L (ROC AUC\u2009=\u20090.763, 95%\u00a0CI 0.675 to 0.850, <jats:italic>p<\/jats:italic>\u2009&lt;\u20090.001) for Group 1, \u2265340 nmol\/L (ROC AUC\u2009=\u20090.688, 95%\u00a0CI 0.615 to 0.761, <jats:italic>p<\/jats:italic>\u2009&lt;\u20090.001) for Group2, and \u2265376\u2009nmol\/L [baseline cortisol] (ROC AUC\u2009=\u20090.783, 95%\u00a0CI 0.708 to 0.859, <jats:italic>p<\/jats:italic>\u2009&lt;\u20090.001) for Group 3, predicted an \u2018SST pass\u2019 with 100% specificity.<\/jats:p><\/jats:sec><jats:sec><jats:title>Conclusions<\/jats:title><jats:p>Adverse effects to synacthen are rare. Pretest morning cortisol is a reliable predictor for SST outcome and is a helpful tool to rationalise use of the SST. Predictive morning\u2010cortisol thresholds vary according to the aetiology of AI.<\/jats:p><\/jats:sec>","DOI":"10.1111\/cen.14934","type":"journal-article","created":{"date-parts":[[2023,6,8]],"date-time":"2023-06-08T08:05:16Z","timestamp":1686211516000},"page":"142-151","update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":14,"title":["\u201cA morning cortisol is the most effective clinical predictor of short synacthen test outcome\u201d: A tertiary care centre experience"],"prefix":"10.1111","volume":"99","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-6309-7140","authenticated-orcid":false,"given":"Shani A. D.","family":"Mathara Diddhenipothage","sequence":"first","affiliation":[{"name":"Oxford Centre for Diabetes, Endocrinology, and Metabolism, Churchill hospital, Oxford University Hospitals NHS Trust Oxford UK"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Katharina J.","family":"Beck","sequence":"additional","affiliation":[{"name":"Oxford Centre for Diabetes, Endocrinology, and Metabolism, Churchill hospital, Oxford University Hospitals NHS Trust Oxford UK"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Helen","family":"Loo","sequence":"additional","affiliation":[{"name":"Oxford Centre for Diabetes, Endocrinology, and Metabolism, Churchill hospital, Oxford University Hospitals NHS Trust Oxford UK"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Gayana K.","family":"Amiyangoda","sequence":"additional","affiliation":[{"name":"Oxford Centre for Diabetes, Endocrinology, and Metabolism, Churchill hospital, Oxford University Hospitals NHS Trust Oxford UK"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Riccardo","family":"Pofi","sequence":"additional","affiliation":[{"name":"Oxford Centre for Diabetes, Endocrinology, and Metabolism, Churchill hospital, Oxford University Hospitals NHS Trust Oxford UK"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Jeremy W.","family":"Tomlinson","sequence":"additional","affiliation":[{"name":"Oxford Centre for Diabetes, Endocrinology, and Metabolism, NIHR Oxford Biomedical Research Centre University of Oxford  Oxford UK"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Aparna","family":"Pal","sequence":"additional","affiliation":[{"name":"Oxford Centre for Diabetes, Endocrinology, and Metabolism, Churchill hospital, Oxford University Hospitals NHS Trust Oxford UK"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"311","published-online":{"date-parts":[[2023,6,8]]},"reference":[{"key":"e_1_2_7_2_1","doi-asserted-by":"publisher","DOI":"10.1016\/S0140-6736(13)61684-0"},{"key":"e_1_2_7_3_1","doi-asserted-by":"publisher","DOI":"10.1056\/NEJM199610173351607"},{"key":"e_1_2_7_4_1","doi-asserted-by":"publisher","DOI":"10.1097\/MAJ.0b013e3181db6b7a"},{"key":"e_1_2_7_5_1","doi-asserted-by":"publisher","DOI":"10.7861\/clinmed.2021-0528"},{"key":"e_1_2_7_6_1","doi-asserted-by":"publisher","DOI":"10.1136\/bmj.l6039"},{"key":"e_1_2_7_7_1","doi-asserted-by":"publisher","DOI":"10.1210\/jc.2005-1131"},{"key":"e_1_2_7_8_1","doi-asserted-by":"publisher","DOI":"10.1210\/jc.2010-0982"},{"key":"e_1_2_7_9_1","doi-asserted-by":"publisher","DOI":"10.1210\/jc.2009-0032"},{"key":"e_1_2_7_10_1","unstructured":"GrossmanAB. 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