{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2025,11,13]],"date-time":"2025-11-13T02:06:58Z","timestamp":1762999618699,"version":"3.40.5"},"reference-count":17,"publisher":"Wiley","issue":"1","license":[{"start":{"date-parts":[[2022,1,20]],"date-time":"2022-01-20T00:00:00Z","timestamp":1642636800000},"content-version":"vor","delay-in-days":19,"URL":"http:\/\/onlinelibrary.wiley.com\/termsAndConditions#vor"}],"content-domain":{"domain":["onlinelibrary.wiley.com"],"crossmark-restriction":true},"short-container-title":["Internal Medicine Journal"],"published-print":{"date-parts":[[2022,1]]},"abstract":"<jats:title>Abstract<\/jats:title><jats:sec><jats:title>Background<\/jats:title><jats:p>The short Synacthen test (SST) is widely used to assess the hypothalamus\u2212pituitary\u2212adrenal axis in the outpatient setting. However, in the inpatient setting, technical difficulties to adhere to the protocol may pose a challenge for using this test.<\/jats:p><\/jats:sec><jats:sec><jats:title>Aims<\/jats:title><jats:p>To find the most suitable basal serum cortisol (BSC) cut\u2010off for predicting an adequate response to the SST in non\u2010critically inpatients without conducting the actual test.<\/jats:p><\/jats:sec><jats:sec><jats:title>Methods<\/jats:title><jats:p>Information was retrieved retrospectively from medical files of 197 patients who had had a 250 \u03bcg SST between the years 2000 and 2016 at the Shaare Zedek Medical Center. BSC, electrolytes, creatinine, thyroid\u2010stimulating hormone, blood counts and blood pressure values were evaluated for a correlation with the results of the SST.<\/jats:p><\/jats:sec><jats:sec><jats:title>Results<\/jats:title><jats:p>A BSC cut\u2010off of 280 nmol\/L provides a negative predictive value of 94% for adrenal insufficiency (AI). Using a cut\u2010off of 380 nmol\/L increases the sensitivity to 96% and yields a negative predictive value of 95.8%.<\/jats:p><\/jats:sec><jats:sec><jats:title>Conclusions<\/jats:title><jats:p>In this study, we found two suitable BSC cut\u2010offs for predicting an adequate response to the SST in hospitalised patients. We suggest using the lower cut\u2010off (280 nmol\/L) for patients with a low level of suspicion for AI and using the higher cut\u2010off (380 nmol\/L) for patients with a higher level of suspicion. A BSC above this cut\u2010off makes the diagnosis of AI very unlikely and precludes the need for a Synacthen test.<\/jats:p><\/jats:sec>","DOI":"10.1111\/imj.15033","type":"journal-article","created":{"date-parts":[[2020,8,24]],"date-time":"2020-08-24T23:36:56Z","timestamp":1598312216000},"page":"105-109","update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":3,"title":["Basal serum cortisol levels predict a normal response to the Synacthen stimulation test in hospitalised patients"],"prefix":"10.1111","volume":"52","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-2360-1170","authenticated-orcid":false,"given":"Lior","family":"Tolkin","sequence":"first","affiliation":[{"name":"Department of Internal Medicine and Endocrine Unit Shaare Zedek Medical Center, affiliated with the Faculty of Medicine, Hebrew University, Jerusalem  Jerusalem Israel"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Michal","family":"Vidberg","sequence":"additional","affiliation":[{"name":"Department of Internal Medicine and Endocrine Unit Shaare Zedek Medical Center, affiliated with the Faculty of Medicine, Hebrew University, Jerusalem  Jerusalem Israel"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-1789-5624","authenticated-orcid":false,"given":"Gabriel","family":"Munter","sequence":"additional","affiliation":[{"name":"Department of Internal Medicine and Endocrine Unit Shaare Zedek Medical Center, affiliated with the Faculty of Medicine, Hebrew University, Jerusalem  Jerusalem Israel"}],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"311","published-online":{"date-parts":[[2022,1,20]]},"reference":[{"key":"e_1_2_6_2_1","doi-asserted-by":"publisher","DOI":"10.1016\/S0300-595X(85)80084-0"},{"key":"e_1_2_6_3_1","doi-asserted-by":"publisher","DOI":"10.1210\/jc.83.7.2350"},{"key":"e_1_2_6_4_1","doi-asserted-by":"publisher","DOI":"10.1016\/S0140-6736(88)92020-X"},{"key":"e_1_2_6_5_1","doi-asserted-by":"publisher","DOI":"10.1055\/s-2008-1070129"},{"key":"e_1_2_6_6_1","doi-asserted-by":"publisher","DOI":"10.1056\/NEJMra020529"},{"key":"e_1_2_6_7_1","doi-asserted-by":"publisher","DOI":"10.1111\/cen.12373"},{"key":"e_1_2_6_8_1","doi-asserted-by":"publisher","DOI":"10.1111\/cen.12585"},{"key":"e_1_2_6_9_1","doi-asserted-by":"publisher","DOI":"10.1111\/j.1445-5994.2010.02306.x"},{"key":"e_1_2_6_10_1","doi-asserted-by":"publisher","DOI":"10.1016\/0002-9343(85)90517-0"},{"key":"e_1_2_6_11_1","doi-asserted-by":"publisher","DOI":"10.1046\/j.1365-2265.1998.00555.x"},{"key":"e_1_2_6_12_1","doi-asserted-by":"publisher","DOI":"10.1111\/j.1365-2265.1987.tb00780.x"},{"key":"e_1_2_6_13_1","doi-asserted-by":"publisher","DOI":"10.1210\/jc.2008-0710"},{"key":"e_1_2_6_14_1","doi-asserted-by":"publisher","DOI":"10.1111\/cen.13128"},{"key":"e_1_2_6_15_1","doi-asserted-by":"publisher","DOI":"10.1097\/MED.0000000000000473"},{"key":"e_1_2_6_16_1","doi-asserted-by":"publisher","DOI":"10.1371\/journal.pone.0225255"},{"key":"e_1_2_6_17_1","doi-asserted-by":"publisher","DOI":"10.4158\/EP-2019-0327"},{"key":"e_1_2_6_18_1","doi-asserted-by":"publisher","DOI":"10.1210\/jcem-72-4-773"}],"container-title":["Internal Medicine Journal"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/onlinelibrary.wiley.com\/doi\/pdf\/10.1111\/imj.15033","content-type":"application\/pdf","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/onlinelibrary.wiley.com\/doi\/full-xml\/10.1111\/imj.15033","content-type":"application\/xml","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/onlinelibrary.wiley.com\/doi\/pdf\/10.1111\/imj.15033","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2023,8,28]],"date-time":"2023-08-28T09:47:24Z","timestamp":1693216044000},"score":1,"resource":{"primary":{"URL":"https:\/\/onlinelibrary.wiley.com\/doi\/10.1111\/imj.15033"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2022,1]]},"references-count":17,"journal-issue":{"issue":"1","published-print":{"date-parts":[[2022,1]]}},"alternative-id":["10.1111\/imj.15033"],"URL":"https:\/\/doi.org\/10.1111\/imj.15033","archive":["Portico"],"relation":{},"ISSN":["1444-0903","1445-5994"],"issn-type":[{"type":"print","value":"1444-0903"},{"type":"electronic","value":"1445-5994"}],"subject":[],"published":{"date-parts":[[2022,1]]},"assertion":[{"value":"2020-04-27","order":0,"name":"received","label":"Received","group":{"name":"publication_history","label":"Publication History"}},{"value":"2020-08-10","order":1,"name":"accepted","label":"Accepted","group":{"name":"publication_history","label":"Publication History"}},{"value":"2022-01-20","order":2,"name":"published","label":"Published","group":{"name":"publication_history","label":"Publication History"}}]}}