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Morning Serum Cortisol Level Predicts Central Adrenal Insufficiency Diagnosed by Insulin Tolerance Test

2021; Karger Publishers; Volume: 111; Issue: 12 Linguagem: Inglês

10.1159/000514216

1423-0194

Valentina Gasco, Chiara Bima, Alice Geranzani, Jacopo Giannelli, Lorenzo Marinelli, Chiara Bona, Valeria Cambria, Alessandro Maria Berton, Nunzia Prencipe, Ezio Ghigo, Mauro Maccario, Silvia Grottoli,

Pituitary Gland Disorders and Treatments

<b><i>Introduction:</i></b> According to guidelines, a morning serum cortisol level &#x3c;83 nmol/L is diagnostic for central adrenal insufficiency (CAI), a value &#x3e;414 nmol/L excludes CAI, while values between 83 and 414 nmol/L require stimulation tests. However, there are no currently reliable data on morning serum cortisol for prediction of cortisol response to insulin tolerance test (ITT). <b><i>Objective:</i></b> Using the receiver-operating characteristic curve analysis, the purpose of this study was to detect the morning serum cortisol cutoff with a specificity (SP) or a sensitivity (SE) above 95% that identify those patients who should not be tested with ITT. <b><i>Methods:</i></b> We included 141 adult patients (83 males) aged 42.7 ± 12.3 (mean ± standard deviation) years old. Based on the serum cortisol response to ITT, patients have been divided into 2 groups: subjects with CAI (peak serum cortisol &#x3c;500 nmol/L; 65 patients) and subjects with preserved adrenocortical function (peak cortisol &#x3e;500 nmol/L; 76 patients). <b><i>Results:</i></b> The best morning cortisol cutoff, in terms of SE (87.7%) and SP (46.1%), was ≤323.3 nmol/L. The cutoff of morning serum cortisol concentration that best predicted a deficient response to ITT was ≤126.4 nmol/L (SE 13.8%, SP 98.7%). The cutoff of morning serum cortisol concentration that best predicted a normal response to ITT was &#x3e;444.7 nmol/L (SE 96.9%, SP 14.5%). <b><i>Conclusions:</i></b> This is the first study that identifies a morning serum cortisol cutoff that best predict the response to ITT in order to simplify the diagnostic process in patients with suspected CAI. A new diagnostic flow-chart for CAI is proposed.