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Title: | The short synacthen test: Variations in methodology and protocols in KSA |
Authors: | Butt, Muhammad I. Alzuhayri, Nouf Riazuddin, Muhammad Bakhsh, Abdulmohsen M.K. |
Keywords: | Addison disease Adrenal insufficiency Cosyntropin Pituitary-adrenal system Short synacthen test |
Issue Date: | 2022 |
Publisher: | Journal of Taibah University Medical Sciences |
Series/Report no.: | Original Article;596-601 |
Abstract: | Objectives: This study aimed to compare the current Kingdom-wide practice with our prior institutional study on use of the short synacthen test (SST), and to determine whether physician specialty or grade is associated with a tendency toward using a particular protocol. Method: We surveyed clinicians registered with the Saudi Medical Council to determine the different SST protocols used within KSA. Results: We received 162 responses, 66 (41%) from endocrinologists and the remainder from internists. A total of 61 (38%) respondents were consultants, whereas the rest were non-consultant grade. The clinicians indicated metabolic derangements, such as hypotension (78%), hyponatremia (65%), hypoglycemia (59%), and hyperkalemia (54%), as the main reasons for performing the test. Most clinicians used the SST protocol, which measures baseline serum cortisol (90%) and ACTH (78%) on the test day. A total of 75% of the physicians measured both the 30- and 60-minute serum cortisol after ACTH injection. Of these clinicians, 13% reported that the cortisol levels were below the pass threshold at 30 min but reached the pass threshold only at 60 min. The SST was normal 90% of the time when performed. A total of 93% of the clinicians considered a stimulated cortisol level of 550 nmol/L to be the threshold for normal adrenal function. Conclusion: The survey confirms that 60-min serum cortisol should be part of the SST protocol to avoid falsepositive results. Moreover, clinicians should consider other causes of these metabolic derangements before requesting a SST, particularly in patients with a low pretest probability. |
URI: | http://localhost:8080/xmlui/handle/123456789/7278 |
ISSN: | 1658-3612 |
Appears in Collections: | Vol 17 No 4 (2022) |
Files in This Item:
File | Description | Size | Format | |
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596-601.pdf | 596-601 | 2.26 MB | Adobe PDF | View/Open |
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