Observational studyThe Journal of clinical endocrinology and metabolism2018
The Short Synacthen (Corticotropin) Test Can Be Used to Predict Recovery of Hypothalamo-Pituitary-Adrenal Axis Function.
Observational study in The Journal of clinical endocrinology and metabolism, 2018. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 29 papers, 3 of them syntheses that pooled it.
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The abstract states no effect estimate the extractor could read, or names no intervention and outcome on the map, so this paper lights no cell and moves no belief. It is still indexed, cited and linked below.
The trial behind it
Trials whose registry record cites this paper, or whose number appears in the abstract. A trial that started after this paper was published is citing it as background, not reporting it.
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Who cites it
29 citing papers in PubMed, 3 syntheses or guidelines pooled it, 66 citations in OpenAlex.
- European Society of Endocrinology and Endocrine Society Joint Clinical Guideline: Diagnosis and Therapy of Glucocorticoid-induced Adrenal Insufficiency.The Journal of clinical endocrinology and metabolism · 2024Guideline
- Idiopathic isolated adrenocorticotropic hormone deficiency: a systematic review of a heterogeneous and underreported disease.Pituitary · 2024Pooled it
- Towards the tailoring of glucocorticoid replacement in adrenal insufficiency: the Italian Society of Endocrinology Expert Opinion.Journal of endocrinological investigation · 2020Guideline
- Article
- New guidelines on glucocorticoid-induced adrenal insufficiency: the end of short synacthen test in rheumatology?RMD open · 2025Article
- A Retrospective Study on Weaning Glucocorticoids and Recovery of the Hypothalamic-Pituitary-Adrenal Axis.The Journal of clinical endocrinology and metabolism · 2024Article
- Predicting postoperative hypocortisolism in patients with non-aldosterone-producing adrenocortical adenoma: a retrospective single-centre study.Journal of endocrinological investigation · 2024Article
- Iatrogenic adrenal insufficiency in adults.Nature reviews. Endocrinology · 2024Review
- Article
- Treating the Side Effects of Exogenous Glucocorticoids; Can We Separate the Good From the Bad?Endocrine reviews · 2023Review
- Multivariable Model to Predict an ACTH Stimulation Test to Diagnose Adrenal Insufficiency Using Previous Test Results.Journal of the Endocrine Society · 2023Article
- COVID-19 pandemic and adrenals: deep insights and implications in patients with glucocorticoid disorders.Endocrine · 2023Review
- Glucocorticoids and cognitive function: a walkthrough in endogenous and exogenous alterations.Journal of endocrinological investigation · 2023Review
- Optimising prednisolone or prednisone replacement in adrenal insufficiency.Endocrine connections · 2023Article
- A Review on Cyclodextrins/Estrogens Inclusion Complexes.International journal of molecular sciences · 2023Review
- Development and internal validation of a predictive score for the diagnosis of central adrenal insufficiency when morning cortisol is in the grey zone.Journal of endocrinological investigation · 2023Article
- Sellar and parasellar lesions in the transition age: a retrospective Italian multi-centre study.Journal of endocrinological investigation · 2023Article
- Adrenal function recovery after durable oral corticosteroid sparing with benralizumab in the PONENTE study.The European respiratory journal · 2022Article
- Normal Adrenal and Thyroid Function in Patients Who Survive COVID-19 Infection.The Journal of clinical endocrinology and metabolism · 2021Observational
- Investigation of the Hypothalamo-pituitary-adrenal (HPA) axis: a contemporary synthesis.Reviews in endocrine & metabolic disorders · 2021Review
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Authors and funding
11 authors at 6 institutions in 3 countries.
Funding
Abstract
Context: The 250-μg short Synacthen (corticotropin) test (SST) is the most commonly used tool to assess hypothalamo-pituitary-adrenal (HPA) axis function. There are many potentially reversible causes of adrenal insufficiency (AI), but no data to guide clinicians as to the frequency of repeat testing or likelihood of HPA axis recovery. Objective: To use the SST results to predict adrenal recovery. Design: A retrospective analysis of 1912 SSTs data. Patients: Seven hundred seventy-six patients with reversible causes of AI were identified who had at least two SSTs performed. A subgroup analysis was performed on individuals previously treated with suppressive doses of glucocorticoids (n = 110). Main Outcome Measures: Recovery of HPA axis function. Results: SST 30-minute cortisol levels above or below 350 nmol/L (12.7 μg/dL) best predicted HPA axis recovery [area under the curve (AUC) receiver operating curve (ROC) = 0.85; median recovery time: 334 vs 1368 days, P = 8.5 × 10-13]: 99% of patients with a 30-minute cortisol >350 nmol/L recovered adrenal function within 4 years, compared with 49% in those with cortisol levels <350 nmol/L. In the subgroup analysis, delta cortisol (30-minute-basal) best predicted the recovery (AUC ROC = 0.77; median recovery time: 262 vs 974 days, P = 7.0 × 10-6). No patient with a delta cortisol <100 nmol (3.6 μg/dL) and a subsequent 1-year random cortisol <200 nmol/L (7.3 μg/dL) recovered HPA axis function. Conclusions: Cortisol levels across an SST can be used to predict recovery of AI and may guide the frequency of repeat testing and inform both clinicians and patients as to the likelihood of restoration of HPA axis function.
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Registered trials
Read under generation 80e0d062 · epoch 390. Bibliography from PubMed, PubMed Central and OpenAlex; grants from NIH RePORTER; trial links from ClinicalTrials.gov; estimates, votes and beliefs from the OpenQuestion graph.