{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,5,7]],"date-time":"2026-05-07T05:12:01Z","timestamp":1778130721073,"version":"3.51.4"},"reference-count":15,"publisher":"SAGE Publications","issue":"3","license":[{"start":{"date-parts":[[2025,10,6]],"date-time":"2025-10-06T00:00:00Z","timestamp":1759708800000},"content-version":"tdm","delay-in-days":0,"URL":"https:\/\/journals.sagepub.com\/page\/policies\/text-and-data-mining-license"}],"content-domain":{"domain":["journals.sagepub.com"],"crossmark-restriction":true},"short-container-title":["Ann Clin Biochem"],"published-print":{"date-parts":[[2026,5]]},"abstract":"<jats:sec>\n                    <jats:title>Introduction<\/jats:title>\n                    <jats:p>Short Synacthen Test (SST), a standard diagnostic test to confirm Adrenal insufficiency (AI), involves substantial expenses.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Objectives<\/jats:title>\n                    <jats:p>This study aimed to assess the predictive value of baseline Cortisol levels for SST outcomes and establish baseline cut-off levels for confirming AI to minimize the necessity of SST.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods<\/jats:title>\n                    <jats:p>All SST data from 2019 to 2024 at National Hospital Kandy, Sri Lanka, were obtained retrospectively. A peak Cortisol \u2265500\u00a0nmol\/L at 30 or 60-min post-SST was considered as a normal adrenal reserve, whereas failure indicated AI. Pearson\u2019s correlation and Logistic Regression analysis assessed baseline and post-SST Cortisol at 30 and 60-min. A 2 \u00d7 2 table assesses test agreement. Receiver operating characteristic (ROC) curve analysis evaluated the SST outcomes at 30 and 60-min separately assessing sensitivity, specificity, and area under the curve (AUC).<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>\n                      A total of 307 patients were enrolled, and 63.19% exhibited a failed SST response. Baseline Cortisol positively correlated with post-SST Cortisol at 30-min (r = 0.74,\n                      <jats:italic toggle=\"yes\">P<\/jats:italic>\n                      &lt; .05) and 60-min (r = 0.68,\n                      <jats:italic toggle=\"yes\">P<\/jats:italic>\n                      &lt; .05) with a good AUC for both 30 min (AUC = 0.855) and 60 min (AUC = 0.829). Baseline Cortisol demonstrated the higher odds ratio per unit (OR = 1.015 per nmol\/L), indicating greater sensitivity to small changes. ROC curves were utilized to derive cut-offs for baseline Cortisol levels predicting SST outcomes. At 30-min, baseline Cortisol &lt;135\u00a0nmol\/L suggests AI (100% sensitivity, 44% specificity), and &gt;381.5\u00a0nmol\/L indicates normal adrenal reserve (100% specificity, 21.8% sensitivity). Similarly at 60-min, baseline Cortisol &lt;75.3\u00a0nmol\/L suggests AI (100% sensitivity, 19.7% specificity), and &gt;357\u00a0nmol\/L indicates normal adrenal reserve (100% specificity, 16.8% sensitivity).\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusions<\/jats:title>\n                    <jats:p>Applying these cut-offs could avoid 41.69% (30 min) or 19% (60 min) of total SSTs, excluding AI and normal adrenal reserve. 30-min SST Cortisol correlates more strongly with baseline Cortisol, showing a higher r-value, higher OR and AUC. Hence, 30-min provides better cut-offs with higher sensitivity and specificity minimizing need for SST. Patients with baseline Cortisol between 135 and 381\u00a0nmol\/L can undergo SST with only a 30-min Cortisol measurement.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1177\/00045632251383417","type":"journal-article","created":{"date-parts":[[2025,9,16]],"date-time":"2025-09-16T02:39:34Z","timestamp":1757990374000},"page":"258-263","update-policy":"https:\/\/doi.org\/10.1177\/sage-journals-update-policy","source":"Crossref","is-referenced-by-count":0,"title":["Predicting the outcome of short Synacthen test based on baseline cortisol levels: A single-centered retrospective cohort study at a tertiary care hospital in Sri Lanka"],"prefix":"10.1177","volume":"63","author":[{"ORCID":"https:\/\/orcid.org\/0009-0001-0301-2192","authenticated-orcid":false,"given":"T","family":"Premadasa","sequence":"first","affiliation":[{"name":"National Hospital"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"EPA","family":"Samarathunga","sequence":"additional","affiliation":[{"name":"National Hospital"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"EM","family":"Sujith","sequence":"additional","affiliation":[{"name":"National Hospital"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"NMF","family":"Shameela","sequence":"additional","affiliation":[{"name":"National Hospital"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"BMKS","family":"Basnayaka","sequence":"additional","affiliation":[{"name":"National Hospital"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"CN","family":"Antonypillai","sequence":"additional","affiliation":[{"name":"National Hospital"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"RDP","family":"Jayawardana","sequence":"additional","affiliation":[{"name":"National Hospital"}],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"179","published-online":{"date-parts":[[2025,10,6]]},"reference":[{"key":"e_1_3_4_2_2","doi-asserted-by":"publisher","DOI":"10.12669\/pjms.35.5.1208"},{"key":"e_1_3_4_3_2","doi-asserted-by":"publisher","DOI":"10.1177\/11795514221093316"},{"key":"e_1_3_4_4_2","doi-asserted-by":"publisher","DOI":"10.1097\/MD.0000000000022621"},{"key":"e_1_3_4_5_2","doi-asserted-by":"publisher","DOI":"10.1016\/j.heliyon.2022.e09559"},{"key":"e_1_3_4_6_2","doi-asserted-by":"publisher","DOI":"10.1111\/cen.12397"},{"key":"e_1_3_4_7_2","first-page":"OC2.2","article-title":"The relationship of baseline, incremental and peak cortisol following a short Synacthen test - single-centre analysis of three years\u2019 data","volume":"58","author":"Aji A","year":"2018","unstructured":"Aji A, Colyer S, Burn S, et al. The relationship of baseline, incremental and peak cortisol following a short Synacthen test - single-centre analysis of three years\u2019 data. Endocr Abstr. 2018; 58: OC2.2.","journal-title":"Endocr Abstr"},{"key":"e_1_3_4_8_2","first-page":"P013","article-title":"Short synacthen test requests may be reduced by considering test indication and identifying a 9 am cortisol value that predicts test result","volume":"50","author":"Wong C","year":"2017","unstructured":"Wong C, Moran C. Short synacthen test requests may be reduced by considering test indication and identifying a 9 am cortisol value that predicts test result. Endocr Abst 2017; 50: P013.","journal-title":"Endocr Abst"},{"key":"e_1_3_4_9_2","doi-asserted-by":"publisher","DOI":"10.1111\/cen.14071"},{"key":"e_1_3_4_10_2","doi-asserted-by":"publisher","DOI":"10.1111\/cen.14934"},{"key":"e_1_3_4_11_2","doi-asserted-by":"publisher","DOI":"10.1136\/postgradmedj-2020-138514"},{"key":"e_1_3_4_12_2","doi-asserted-by":"publisher","DOI":"10.4158\/EP171861.OR"},{"key":"e_1_3_4_13_2","doi-asserted-by":"publisher","DOI":"10.1111\/cen.13232"},{"issue":"2","key":"e_1_3_4_14_2","first-page":"S4","article-title":"ESICON 2017 abstracts","volume":"21","author":"Samarasinghe GPGP","year":"2017","unstructured":"Samarasinghe GPGP, Ekanayake EMSB, Antonypillai CN. ESICON 2017 abstracts. Indian Journal of Endocrinology and Metabolism 2017; 21(Suppl 2): S4\u2013S79.","journal-title":"Indian Journal of Endocrinology and Metabolism"},{"key":"e_1_3_4_15_2","doi-asserted-by":"publisher","DOI":"10.1210\/jc.2018-00529"},{"key":"e_1_3_4_16_2","doi-asserted-by":"publisher","DOI":"10.1210\/jendso\/bvad127"}],"container-title":["Annals of Clinical Biochemistry: International Journal of Laboratory Medicine"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/journals.sagepub.com\/doi\/pdf\/10.1177\/00045632251383417","content-type":"application\/pdf","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/journals.sagepub.com\/doi\/full-xml\/10.1177\/00045632251383417","content-type":"application\/xml","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/journals.sagepub.com\/doi\/pdf\/10.1177\/00045632251383417","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2026,5,7]],"date-time":"2026-05-07T04:24:48Z","timestamp":1778127888000},"score":1,"resource":{"primary":{"URL":"https:\/\/journals.sagepub.com\/doi\/10.1177\/00045632251383417"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2025,10,6]]},"references-count":15,"journal-issue":{"issue":"3","published-print":{"date-parts":[[2026,5]]}},"alternative-id":["10.1177\/00045632251383417"],"URL":"https:\/\/doi.org\/10.1177\/00045632251383417","relation":{},"ISSN":["0004-5632","1758-1001"],"issn-type":[{"value":"0004-5632","type":"print"},{"value":"1758-1001","type":"electronic"}],"subject":[],"published":{"date-parts":[[2025,10,6]]}}}