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Randomised, placebo-controlled, double-blinded, four-way crossover trial to demonstrate the comparative pharmacodynamic equivalence of a non-invasive diagnostic test for adrenal insufficiency in a healthy population: the STARLIT-2 study protocol.
BMJ Open
December 2024
Clinical Medicine, School of Medicine and Population Health, The University of Sheffield, Sheffield, UK
Introduction: Cortisol is an essential stress hormone and failure of its production, known as adrenal insufficiency (AI), is associated with significant mortality due to adrenal crisis. The Short Synacthen Test (SST) is the current diagnostic test of choice for AI, but it is both invasive and resource intensive. Globally, there is an unmet need for a non-invasive, cost-effective test.
View Article and Find Full Text PDFImpact of Surreptitious Glucocorticoids in Over-the-Counter Arthritis Supplements.
J Endocr Soc
January 2025
Division of Endocrinology and Diabetes, Keck Medicine of USC, Los Angeles, CA 90033, USA.
Adrenal dysfunction due to over-the-counter (OTC) health supplements containing unlabeled glucocorticoids has been previously reported. Here, we present a case series of 12 patients at an urban safety net medical center evaluated by endocrinology for iatrogenic adrenal dysfunction, Cushing syndrome (CS) and/or adrenal insufficiency (AI), associated with use of OTC arthritis supplements surreptitiously containing glucocorticoids. There were 12 patients using OTC arthritis supplements (Artri King [n = 8], Ardosons [n = 3], Ajo Rey [n = 1]) included.
View Article and Find Full Text PDFIntroduction: Consensus regarding the diagnostic cutoff values for cortisol responses to low-dose Cosyntropin testing (LDT) and its specific advantages over standard (high) dose test (HDT) in assessing the pituitary-adrenal axis in children is lacking.
Methods: In a retrospective study, patients who underwent sequential LDT and HDT were classified into two groups depending on the reason for testing: prolonged systemic glucocorticoid exposure (Group 1) or suspected hypothalamic-pituitary dysfunction (Group 2). Sensitivity and specificity analysis of varying cortisol levels during LDT in diagnosing ACTH deficiency (ACTHD) were calculated via the receiver operating characteristic curve (ROC) analysis against the reference diagnostic test HDT.
Performance of dehydroepiandrosterone sulfate and baseline cortisol in assessing adrenal insufficiency.
J Clin Endocrinol Metab
December 2024
Division of Endocrinology, Diabetes, Metabolism and Nutrition, Mayo Clinic, Rochester, Minnesota, 55905.
Context: Diagnosing adrenal insufficiency (AI) often requires complex testing which can be time consuming and expensive. Dehydroepiandrosterone sulfate (DHEAS) is a promising marker of hypothalamic-pituitary-adrenal (HPA) axis function, however its diagnostic performance has not yet been evaluated in a large-scale study.
Objective: Evaluate the performance of DHEAS and baseline cortisol in assessing AI.
Investigating the Clinical Appropriateness of Short Synacthen Testing and Utility of Pretest Cortisol to Predict Short Synacthen Testing Outcomes: A Tertiary Center Experience in Southeast Asia.
Endocr Pract
January 2025
Department of Medicine, National University of Singapore, Singapore, Singapore; Division of Endocrinology, Department of Medicine, National University Hospital, Singapore, Singapore.
Objective: No studies have investigated the predictors of an adequate cortisol response to the short synacthen test (SST) and the appropriateness of patient selection for SST in the Southeast Asian population. The aim of our study is to investigate the predictors and indications of SSTs and concondance of SSTs conducted with outcomes.
Methods: This is a retrospective study investigating all SSTs performed over a year in a tertiary center.
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