Accuracy of the Low-Dose ACTH Stimulation Test for Adrenal Insufficiency Diagnosis: A Re-Assessment of the Cut-Off Value.
adrenal insufficiency
cortisol levels
low-dose ACTH test stimulation
Journal
Journal of clinical medicine
ISSN: 2077-0383
Titre abrégé: J Clin Med
Pays: Switzerland
ID NLM: 101606588
Informations de publication
Date de publication:
05 Jun 2019
05 Jun 2019
Historique:
received:
13
04
2019
revised:
28
05
2019
accepted:
01
06
2019
entrez:
15
6
2019
pubmed:
15
6
2019
medline:
15
6
2019
Statut:
epublish
Résumé
The clinical practice shows that many low-dose ACTH-stimulation tests have a false positive result. The aim of the study was to determine the diagnostic accuracy of a low-dose ACTH-stimulation test in the diagnosis of adrenal insufficiency and to define its optimal cut-off. We analyzed data from 103 patients undergoing 1 µg ACTH-stimulation test. Four patients had adrenal insufficiency (AI) upon follow up: Two primary, and two secondary AI. Cortisol serum levels were evaluated at time 0, 20', and 30' after the injection of 1 µg i.v. of ACTH. The sensitivity, specificity, accuracy, and positive and negative predictive values of the test were calculated for both 20' and 30' sampling. The receiver operating characteristic (ROC) curve was obtained to assess the sensitivity and specificity of low-dose ACTH-stimulation test in the diagnosis of adrenal insufficiency at different cut-off values. Considering 500 nmol/L as the standard cut-off value, low-dose ACTH stimulation test showed a 100% sensitivity and a 67.3% specificity, with a high rate of false positive results. ROC curve analysis showed that the cut-off of 401.5 nmol/L is the best compromise between sensitivity (100%) and specificity (93.9%). By using a cut-off value of 401.5 nmol/L for the low-dose ACTH stimulation test, the number of false positive patients decreased significantly, but the sensitivity remained high.
Sections du résumé
BACKGROUND
BACKGROUND
The clinical practice shows that many low-dose ACTH-stimulation tests have a false positive result. The aim of the study was to determine the diagnostic accuracy of a low-dose ACTH-stimulation test in the diagnosis of adrenal insufficiency and to define its optimal cut-off.
METHODS
METHODS
We analyzed data from 103 patients undergoing 1 µg ACTH-stimulation test. Four patients had adrenal insufficiency (AI) upon follow up: Two primary, and two secondary AI. Cortisol serum levels were evaluated at time 0, 20', and 30' after the injection of 1 µg i.v. of ACTH. The sensitivity, specificity, accuracy, and positive and negative predictive values of the test were calculated for both 20' and 30' sampling. The receiver operating characteristic (ROC) curve was obtained to assess the sensitivity and specificity of low-dose ACTH-stimulation test in the diagnosis of adrenal insufficiency at different cut-off values.
RESULTS
RESULTS
Considering 500 nmol/L as the standard cut-off value, low-dose ACTH stimulation test showed a 100% sensitivity and a 67.3% specificity, with a high rate of false positive results. ROC curve analysis showed that the cut-off of 401.5 nmol/L is the best compromise between sensitivity (100%) and specificity (93.9%).
CONCLUSIONS
CONCLUSIONS
By using a cut-off value of 401.5 nmol/L for the low-dose ACTH stimulation test, the number of false positive patients decreased significantly, but the sensitivity remained high.
Identifiants
pubmed: 31195750
pii: jcm8060806
doi: 10.3390/jcm8060806
pmc: PMC6616948
pii:
doi:
Types de publication
Journal Article
Langues
eng
Références
Clin Endocrinol (Oxf). 1999 Aug;51(2):153-8
pubmed: 10468984
Clin Endocrinol (Oxf). 2000 May;52(5):633-40
pubmed: 10792344
Lancet. 2003 May 31;361(9372):1881-93
pubmed: 12788587
J Clin Endocrinol Metab. 2007 Apr;92(4):1326-33
pubmed: 17244781
Exp Clin Endocrinol Diabetes. 2010 Mar;118(3):151-7
pubmed: 19358090
Ann Clin Biochem. 2010 Mar;47(Pt 2):158-64
pubmed: 20150215
J Clin Endocrinol Metab. 2016 Feb;101(2):427-34
pubmed: 26649617
J Clin Endocrinol Metab. 2016 Feb;101(2):364-89
pubmed: 26760044
Eur J Endocrinol. 2016 Sep;175(3):R107-16
pubmed: 27068688
Clin Endocrinol (Oxf). 1995 Sep;43(3):311-5
pubmed: 7586600
J Clin Endocrinol Metab. 1995 Apr;80(4):1243-6
pubmed: 7714095
J Clin Endocrinol Metab. 1995 Apr;80(4):1301-5
pubmed: 7714104
Crit Care Med. 1993 Sep;21(9):1339-47
pubmed: 8396524
Clin Endocrinol (Oxf). 1996 Feb;44(2):151-6
pubmed: 8849568