Author: Blair J.; Lancaster G.; Titman A.; Peak M.; Newlands P.; Collingwood C.; Chesters C.; Moorcroft T.; Wallin N.; Hawcutt D.; Gardner C.; Didi M.; Lacy D.; Couriel J.
Abstract: Objective: To examine serum cortisol responses to a simplified low-dose short Synacthen test (LDSST) in children treated with inhaled corticosteroids (ICS) for asthma and to compare these to early morning salivary cortisol (EMSC) and cortisone (EMSCn) levels. Design: Early morning salivary cortisol and EMSCn samples were collected for three consecutive days. On day three, Synacthen 500 ng/1.73 m<sup>2</sup> was administered intravenously. Samples were collected at 0, 15, 25, 35 min. Results: A total of 269 subjects (160 M: 109 F), median (range) age 10.0 (5.1-15.2) years were studied. Peak cortisol in the LDSST was <500 nmol/l in 101 subjects (37.5%) and <350 nmol/l in 12 subjects (4.5%). Basal cortisol correlated with peak cortisol: r = 0.55, (95% CI: 0.46, 0.63, P < 0.0001). Time at which peak cortisol concentration was achieved was significantly related to the value of peak cortisol (P < 0.0001), with higher cortisol peaks occurring later in the test and lower cortisol peaks occurring earlier. EMSC and EMSCn had no predictive value for the identification of patients with a peak cortisol < 500 nmol/l. EMSCn was superior to EMSC in identifying patients with a peak cortisol < 350 nmol/l: a minimum EMSCn cut-off value of 12.5 nmol/l gave a negative predictive value of 99.2% and positive predictive value of 30.1%. Conclusion: Our data illustrate that basal measures of cortisol are likely to be of value in screening populations for patients at greatest risk of adrenal crisis. EMSCn shows promise as a screening tool for the
identification of patients with severe adrenal insufficiency. 2013 John Wiley & Sons Ltd.
For more information about obtaining the full text of journal
articles, please visit our Document / Book Supply service.
