Fig. 1Subject enrollment. TSA, transshenoidal approach; ACC, adrenal cortical carcinoma; SST, short synacthen test; HPA, hypothalamic-pituitary-adrenal.
Fig. 2The area under the receiver operating characteristic curve to assess the ability of the serum cortisol increment (delta cortisol) to predict the hypothalamic-pituitary-adrenal axis recovery after the first short synacthen test. A peak cortisol cut-off of ≥8.15 µg/dL gives a sensitivity of 50% and a specificity of 79%, and that of ≥8.99 µg/dL gives a sensitivity of 40% and a specificity of 86% for predicting adrenal function recovery.
Table 1Patients Characteristics and Results of Standard-Dose Short Synacthen Test
Characteristic |
Total |
Non-responders |
Responders |
P valuea
|
No. of patients |
34 |
14 |
20 |
|
Age, yr |
69.5 (60.5–75.3) |
70.5 (63.5–76.3) |
67.0 (59.5–74.3) |
0.436 |
Male sex |
14 (41.2) |
4 (28.6) |
10 (50.0) |
0.211b
|
Body mass index, kg/m2
|
22.4 (18.8–25.1) |
22.0 (18.1–24.0) |
23.0 (19.9–25.9) |
0.424 |
Time interval from diagnosis to performing a follow-up SST, mo |
16.5 (13.8–20.0) |
18.5 (14.8–20.3) |
15.5 (13.0–18.8) |
0.217 |
Cushingoid feature at first SST |
16 (47.1) |
6 (37.5) |
10 (62.5) |
>0.999c
|
Disease state |
|
|
|
0.277 |
Rheumatic diseased
|
4 (11.8) |
1 (7.1) |
3 (15.0) |
Orthopedic diseasee
|
23 (67.6) |
11 (78.6) |
12 (60.0) |
Chronic lung diseasef
|
3 (8.8) |
1 (7.1) |
2 (10.0) |
Malignancy with chemotherapyg
|
4 (11.8) |
1 (7.1) |
3 (15.0) |
Serum albumin, mg/dL |
3.6 (3.2–4.1) |
3.6 (3.2–4.1) |
3.6 (3.3–4.1) |
0.691 |
Basal serum ACTH, pg/mL |
7.5 (1.0–24.3) |
13.2 (1.0–38.2) |
6.3 (1.0–16.5) |
0.436 |
Serum cortisol (basal), µg/dL |
2.33 (0.72–5.83) |
3.40 (0.52–7.28) |
2.22 (0.81–5.42) |
>0.999 |
Serum cortisol (peak), µg/dL |
11.21 (7.20–14.35) |
9.11 (4.09–14.37) |
11.67 (8.54–14.40) |
0.148 |
Δ Serum cortisol, µg/dLh
|
6.70 (4.00–10.00) |
3.56 (2.44–7.93) |
7.88 (6.23–10.87) |
0.004 |
Table 2Logistic Regression of Basal Serum ACTH and Cortisol, Peak Serum Cortisol, and Serum Cortisol Increment in Relation to Adrenal Function Recovery
Variable |
OR (95% CI) |
Univariate analysis |
Model 1a
|
Model 2b
|
Modelc
|
Basal ACTH, pg/mL |
0.99 (0.97–1.01) |
|
|
|
Serum cortisol (basal), µg/dL |
0.94 (0.78–1.13) |
|
|
|
Serum cortisol (peak), µg/dL |
1.15 (0.97–1.35) |
|
|
|
Δ Serum cortisol, µg/dLd
|
1.48 (1.10–1.97) |
1.45 (1.03–2.05) |
1.44 (1.01–2.05) |
1.58 (1.02–2.46) |