Session: SUN 50-71-HPA Axis
Poster Board SUN-61
Method: The data for 123 patients in our tertiary hospital who underwent SST in the last 2 years was collected prospectively by interview and clinical notes.
Results and discussion: A total of 44 (35.8%) patients failed SST: 60min cortisol <20µg/dl (550nmol/L). Chronic steroid use (mostly TCM) is the commonest cause for failed SST (28/44, 63.6%) in our cohort. The percentage of important symptoms and signs in those who failed SST is as follows: weight loss (63.6%), fatigue (52.3%), giddiness (50.0%), hyponatraemia (35.0%) and postural hypotension (15.9%). However, positive predictive values for these symptoms and signs were quite low and not significant.
Our results also showed 52.0% of the patients failed the SST at 30min, compared to 35.8% who failed at 60min (p=0.01), suggesting that the use of a 30min cutoff may over-diagnose hypocortisolism. All patients with either a random or 8am cortisol ≥14.5µg/dl (400nmol/L), eventually passed SST, suggesting that these patients (15.2%) could have avoided an SST.
We observed a low usage of ACTH measurements in our clinical practice, and hence we are unable to draw any conclusion of its usefulness from our limited data. However, the combination of a robust cortisol and ACTH done at 8am could be very helpful in diagnosing adrenal insufficiency, and may reduce the frequency of SST in clinical practice.
Nothing to Disclose: EC, SL, RH, SA
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