Cross, A.S., Kemp, E.H. orcid.org/0000-0002-0313-8916, White, A. et al. (7 more authors) (2018) International survey on high- and low-dose synacthen test and assessment of accuracy in preparing low-dose synacthen. Clinical Endocrinology , 88 (5). pp. 744-751. ISSN 0300-0664
Abstract
OBJECTIVE: The short synacthen test (SST) is widely used to assess patients for adrenal insufficiency but the frequency and protocols used across different centres for the low-dose test (LDT) are unknown. This study aimed to survey centres and test the accuracy of ten different synacthen preparation strategies used for the LDT. METHODS: Members of six international endocrine societies were surveyed regarding diagnostic tests used for adrenal insufficiency, and in particular the SST. Synacthen was diluted for the LDT and concentrations measured using a synacthen ELISA. RESULTS: Survey responses were received from 766 individuals across 60 countries (52% adult, 45% paediatric endocrinologists). The SST is used by 98% of centres: 92% using high-dose (250 μg), 43% low-dose, and 37% both. Ten low-dose dilution methods were assessed and variation in synacthen concentration was demonstrated with intra-method coefficients of variation (CV) ranging from 2.1% to 109%. The method using 5% dextrose as a diluent was the least variable (CV of 2.1%). The variation in dilution methods means that the dose of synacthen administered in a LDT may vary between 0.16 μg and 0.81 μg. CONCLUSIONS: The high-dose SST is the most popular diagnostic test of adrenal insufficiency but up to 72% of paediatric endocrinologists use a LDT. There is considerable variation observed both within and between low-dose synacthen dilution methods creating considerable risk of inaccurate dosing and thereby invalid results.
Metadata
Item Type: | Article |
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Authors/Creators: |
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Copyright, Publisher and Additional Information: | This is the peer reviewed version of the following article: Cross, A. S., Kemp, E. H., White, A., Walker, L., Meredith, S., Sachdev, P., Krone, N. P., Ross, R. J., Wright, N. P. and Elder, C. J. (2018), International survey on high- and low-dose synacthen test and assessment of accuracy in preparing low-dose synacthen. Clin Endocrinol., which has been published in final form at https://doi.org/10.1111/cen.13559. This article may be used for non-commercial purposes in accordance with Wiley Terms and Conditions for Self-Archiving. |
Keywords: | Dilution; low-dose synacthen; pituitary-adrenal function tests; questionnaires; surveys |
Dates: |
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Institution: | The University of Sheffield |
Academic Units: | The University of Sheffield > Faculty of Medicine, Dentistry and Health (Sheffield) > The Medical School (Sheffield) > Division of Genomic Medicine (Sheffield) > Department of Oncology and Metabolism (Sheffield) The University of Sheffield > Sheffield Teaching Hospitals |
Depositing User: | Symplectic Sheffield |
Date Deposited: | 07 Feb 2018 11:22 |
Last Modified: | 01 May 2020 07:11 |
Published Version: | https://doi.org/10.1111/cen.13559 |
Status: | Published |
Publisher: | Wiley |
Refereed: | Yes |
Identification Number: | 10.1111/cen.13559 |
Related URLs: | |
Open Archives Initiative ID (OAI ID): | oai:eprints.whiterose.ac.uk:127049 |