{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,8,18]],"date-time":"2026-08-18T00:52:40Z","timestamp":1787014360571,"version":"build-2736575974"},"reference-count":22,"publisher":"Wiley","issue":"9","license":[{"start":{"date-parts":[[2024,4,25]],"date-time":"2024-04-25T00:00:00Z","timestamp":1714003200000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/creativecommons.org\/licenses\/by-nc\/4.0\/"}],"content-domain":{"domain":["onlinelibrary.wiley.com"],"crossmark-restriction":true},"short-container-title":["Internal Medicine Journal"],"published-print":{"date-parts":[[2024,9]]},"abstract":"<jats:title>Abstract<\/jats:title>\n                  <jats:sec>\n                    <jats:title>Background<\/jats:title>\n                    <jats:p>The short Synacthen test (SST) is widely used to investigate adrenal insufficiency, but it can be time\u2010consuming, costly and labour\u2010intensive to perform and is not without risk of adverse events.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Aim<\/jats:title>\n                    <jats:p>To review SST requesting patterns and practices across public hospitals in Queensland.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods<\/jats:title>\n                    <jats:p>The electronic medical records of patients who underwent a SST with Pathology Queensland between January 2020 and December 2020 were reviewed to collect data regarding the indication for the test, the requesting speciality, SST results and any adverse events.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>\n                      Six hundred and fifty\u2010two SSTs were identified, of which 363 individual patients were included in the analysis. The majority of the tests (\n                      <jats:italic>n<\/jats:italic>\n                      =\u2009198, 54.5%) were performed in the inpatient setting. Endocrinology most commonly ordered SSTs (\n                      <jats:italic>n<\/jats:italic>\n                      =\u2009188, 51.8%). The suspected aetiology of adrenal insufficiency was unclear in a large proportion of requests (\n                      <jats:italic>n<\/jats:italic>\n                      =\u2009167, 46.0%). Static testing of morning cortisol prior to SST was performed in only 249 (68.6%) patients. Of 140 inpatients data, 17.9% (\n                      <jats:italic>n<\/jats:italic>\n                      = 25) showed a robust static cortisol of \u2265400 nmol\/L and were treated as having normal adrenal function, suggesting SST was unnecessary in these patients. Twenty\u2010two (6.1%) patients had a documented adverse event occurring during or after the SST.\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusions<\/jats:title>\n                    <jats:p>There was wide variability in requesting patterns and practices for SSTs across Queensland. More than one in six SSTs could have been avoided if a static morning cortisol had been performed prior. Clinician education and the adoption of a structured referral form may improve testing practices.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1111\/imj.16383","type":"journal-article","created":{"date-parts":[[2024,4,25]],"date-time":"2024-04-25T05:27:06Z","timestamp":1714022826000},"page":"1515-1522","update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":2,"title":["A retrospective review of the short Synacthen test in Queensland hospitals"],"prefix":"10.1111","volume":"54","author":[{"ORCID":"https:\/\/orcid.org\/0000-0003-2869-1918","authenticated-orcid":false,"given":"Elizabeth","family":"Wootton","sequence":"first","affiliation":[{"name":"Department of Endocrinology and Diabetes Royal Brisbane and Women's Hospital  Brisbane Queensland Australia"},{"name":"Faculty of Medicine The University of Queensland  Brisbane Queensland Australia"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Quynh","family":"Truong","sequence":"additional","affiliation":[{"name":"Department of Endocrinology and Diabetes Royal Brisbane and Women's Hospital  Brisbane Queensland Australia"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Carel J.","family":"Pretorius","sequence":"additional","affiliation":[{"name":"Faculty of Medicine The University of Queensland  Brisbane Queensland Australia"},{"name":"Department of Chemical Pathology Pathology Queensland  Brisbane Queensland Australia"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-8451-2385","authenticated-orcid":false,"given":"Matthew","family":"Balcerek","sequence":"additional","affiliation":[{"name":"Department of Endocrinology and Diabetes Royal Brisbane and Women's Hospital  Brisbane Queensland Australia"},{"name":"Faculty of Medicine The University of Queensland  Brisbane Queensland Australia"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Syndia","family":"Lazarus","sequence":"additional","affiliation":[{"name":"Department of Endocrinology and Diabetes Royal Brisbane and Women's Hospital  Brisbane Queensland Australia"},{"name":"Department of Chemical Pathology Pathology Queensland  Brisbane Queensland Australia"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"311","published-online":{"date-parts":[[2024,4,25]]},"reference":[{"key":"e_1_2_7_2_1","volume-title":"Harmonisation of Endocrine Dynamic Testing \u2013 Adult (HEDTA)","author":"Chiang C","year":"2021"},{"key":"e_1_2_7_3_1","doi-asserted-by":"publisher","DOI":"10.7326\/0003-4819-139-3-200308050-00009"},{"key":"e_1_2_7_4_1","doi-asserted-by":"publisher","DOI":"10.1210\/jc.2015-1700"},{"key":"e_1_2_7_5_1","doi-asserted-by":"publisher","DOI":"10.1056\/NEJMe2113200"},{"key":"e_1_2_7_6_1","doi-asserted-by":"publisher","DOI":"10.1258\/0004563001899410"},{"key":"e_1_2_7_7_1","doi-asserted-by":"publisher","DOI":"10.1210\/jc.2015-1710"},{"key":"e_1_2_7_8_1","doi-asserted-by":"publisher","DOI":"10.1111\/joim.12162"},{"key":"e_1_2_7_9_1","first-page":"4364","article-title":"Anaphylactic shock with fatal outcome after injection of synthetic corticotropin (Synacthen Depot) in a patient with severe asthma","volume":"67","author":"Abjorn C","year":"1970","journal-title":"Lakartidningen"},{"key":"e_1_2_7_10_1","doi-asserted-by":"publisher","DOI":"10.1055\/s-0029-1225630"},{"key":"e_1_2_7_11_1","doi-asserted-by":"publisher","DOI":"10.1210\/jc.2002-021897"},{"key":"e_1_2_7_12_1","doi-asserted-by":"publisher","DOI":"10.1111\/cen.12373"},{"key":"e_1_2_7_13_1","doi-asserted-by":"publisher","DOI":"10.1111\/cen.13232"},{"key":"e_1_2_7_14_1","doi-asserted-by":"publisher","DOI":"10.1136\/postgradmedj-2020-138514"},{"key":"e_1_2_7_15_1","first-page":"9","article-title":"Appropriateness of adrenocorticotropic hormone stimulation test for critically ill patients","volume":"63","author":"Sin O","year":"2010","journal-title":"Can J Hosp Pharm"},{"key":"e_1_2_7_16_1","doi-asserted-by":"publisher","DOI":"10.1056\/NEJMoa071366"},{"key":"e_1_2_7_17_1","first-page":"106","article-title":"Outpatient synacthen testing in a large metropolitan region: a clinical audit","volume":"135","author":"Walters A","year":"2022","journal-title":"N Z Med J"},{"key":"e_1_2_7_18_1","doi-asserted-by":"publisher","DOI":"10.1177\/11795514221093316"},{"key":"e_1_2_7_19_1","doi-asserted-by":"publisher","DOI":"10.7861\/clinmedicine.16-3-299"},{"key":"e_1_2_7_20_1","doi-asserted-by":"publisher","DOI":"10.1111\/j.1742-6723.2010.01307.x"},{"key":"e_1_2_7_21_1","unstructured":"Endocrine Society of Australia RACoP. The Endocrine Society of Australia Evolve Top\u20105 Recommendations on Low\u2010Value Practices; 2021. Available from URL:https:\/\/evolve.edu.au\/recommendations\/esa."},{"key":"e_1_2_7_22_1","doi-asserted-by":"publisher","DOI":"10.1111\/ajo.13021"},{"key":"e_1_2_7_23_1","volume-title":"COVID\u201019 Australia: Epidemiology Report 32","author":"Communicable Diseases Intelligence","year":"2021"}],"container-title":["Internal Medicine Journal"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/onlinelibrary.wiley.com\/doi\/pdf\/10.1111\/imj.16383","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2024,9,6]],"date-time":"2024-09-06T09:03:56Z","timestamp":1725613436000},"score":1,"resource":{"primary":{"URL":"https:\/\/onlinelibrary.wiley.com\/doi\/10.1111\/imj.16383"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2024,4,25]]},"references-count":22,"journal-issue":{"issue":"9","published-print":{"date-parts":[[2024,9]]}},"alternative-id":["10.1111\/imj.16383"],"URL":"https:\/\/doi.org\/10.1111\/imj.16383","archive":["Portico"],"relation":{},"ISSN":["1444-0903","1445-5994"],"issn-type":[{"value":"1444-0903","type":"print"},{"value":"1445-5994","type":"electronic"}],"subject":[],"published":{"date-parts":[[2024,4,25]]},"assertion":[{"value":"2023-09-10","order":0,"name":"received","label":"Received","group":{"name":"publication_history","label":"Publication History"}},{"value":"2024-03-11","order":2,"name":"accepted","label":"Accepted","group":{"name":"publication_history","label":"Publication History"}},{"value":"2024-04-25","order":3,"name":"published","label":"Published","group":{"name":"publication_history","label":"Publication History"}}]}}