New Cortisol Thresholds for the Diagnosis of Adrenal Insufficiency Using the Low-Dose Synacthen Test in Children on Long-Term Corticosteroids: A North African Pilot Study
Rattachement africain : Tunisie, kw. Niveau de preuve : code pays fourni par la source.
Le résumé fourni par la source
Background: The low-dose Synacthen stimulation test (LD-SST) is the reference dynamic test for diagnosing glucocorticoid-induced adrenal insufficiency (AI) in children, but it is resource-intensive and costly. This study aimed to establish morning cortisol thresholds predictive of hypothalamic–pituitary–adrenal (HPA) axis response to LD-SST in pediatric patients receiving chronic corticosteroid therapy. Methods: We conducted a prospective study including 71 children (mean age 6.23 ± 3.49 years; 57.7% male) receiving prolonged oral or inhaled corticosteroids. All patients underwent LD-SST with cortisol measurements at 0, 30, and 60 min. Patients were classified as having AI (peak cortisol < 18 μg/dL at T30 or T60, n = 39) or normal adrenal function (peak cortisol ≥ 18 μg/dL, n = 32). ROC curve analysis determined optimal cortisol thresholds for predicting AI. Results: Among the 71 patients, 44 received inhaled corticosteroids (62%) and 27 oral corticosteroids (38%). Asthma (61.9%) and autoimmune diseases (18.3%) were the main indications. The prevalence of AI was 54.9% (n = 39). Mean morning cortisol was significantly lower in the AI group compared to the normal group (6.69 ± 1.99 vs. 9.21 ± 2.49 μg/dL, p < 0.001). ROC analysis identified a morning cortisol <6 μg/dL as predictive of AI with 96.9% sensitivity and 46.2% specificity (AUC = 0.823), while a threshold >13 μg/dL predicted normal HPA function with 100% specificity. Using these thresholds would have avoided LD-SST in 29.6% of patients. The cortisol increment following stimulation also demonstrated diagnostic value (AUC = 0.822), with an increment <9 μg/dL suggesting AI and ≥9 μg/dL likely excluding the diagnosis. Conclusions: In this North African pilot study, morning cortisol measurement at 7 days after oral corticosteroid withdrawal predicted LD-SST response. A threshold of ≤6 μg/dL identified patients with persistent HPA suppression with high sensitivity (97.4%), while ≥13 μg/dL identified patients with preserved function with high specificity (100%). However, the 7-day washout period might be insufficient for complete HPA recovery; therefore, these thresholds reflect residual suppression rather than permanent adrenal insufficiency.
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Le contrôle bibliographique ouvert
DOI retrouvé dans Crossref DOI retrouvé ; titre concordant.
- Titre Crossref
- New Cortisol Thresholds for the Diagnosis of Adrenal Insufficiency Using the Low-Dose Synacthen Test in Children on Long-Term Corticosteroids: A North African Pilot Study
- Date Crossref
- 01/04/2026
- Éditeur
- MDPI AG
- Type
- journal-article
Ce recoupement confirme des métadonnées liées au DOI. Il ne confirme ni la méthode ni les conclusions de l’étude, et il ne compte pas comme une seconde source scientifique indépendante.
Où se fait cette recherche
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Hôpital Farhat Hached Tunisie (code pays fourni par la source)Établissement de santé
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University of Sousse University of Sousse, Tunisie (code pays fourni par la source)Université ou école supérieure
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Ibn Sina Hospital pays non établi dans la noticeÉtablissement de santé
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University of Kairouan University of Kairouan, Tunisie (code pays fourni par la source)Université ou école supérieure
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University Hospital of Farhat Hached Department of Endocrinology Sousse, Tunisie (pays nommé en fin d’affiliation)Université ou école supérieure
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Faculty of Medicine of Sousse Department of Pediatrics Faculty of Medicine of Sousse, Tunisie (pays nommé en fin d’affiliation)Université ou école supérieure
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Laboratory of Exercise Physiology and Pathophysiology Sousse, Tunisie (pays nommé en fin d’affiliation)Structure de recherche
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University Hospital Ibn El Jazzar Department of Endocrinology Kairouan, Tunisie (pays nommé en fin d’affiliation)Université ou école supérieure
Hôpital Farhat Hached (Tunisie), University of Sousse (University of Sousse, Tunisie) et Ibn Sina Hospital, avec 5 autres affiliations. Pays d’affiliation : Tunisie.
Une affiliation ne permet pas de déduire la nationalité d’un auteur.