Perton, F. (Frank) (2015) Het beperken van onnodige ACTH stimulatietesten; een beoordeling van basaal cortisol afkapwaarden en andere voorspellende variabelen. thesis, Medicine.
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Abstract
Objective: to find new guidelines for diagnosing adrenal insufficiency in order to reduce the number of low dose short Synacthen tests (LD-SST’s) performed in an outpatient setting. This was done firstly by determining optimal cutoff values for screening basal cortisol tests and secondly by analysing the role of several variables in predicting the outcome of the LD-SST. Materials and methods: Optimal basal cortisol cut-off values were determined by ROC analysis of 145 outpatient LD-SST’s. Subsequently the predictive value of several variables were analysed using univariate and multivariable logistic regression analyses. In a second study the predictive variables were analysed in a group consisting of 329 outpatient LD-SST’s, in which also tests without a known basal cortisol value were included. Results: A basal cortisol lower cut-off value of 145 nmol/L (specificity 89.9%, positive predictive value 90.0%) and an upper cut-off value of 375 nmol/L (sensitivity 100%, negative predictive value 100%) were found. A normal LD-SST was predicted by chronic fatigue symptoms, hypotension/ orthostasis symptoms and also autoimmune diseases associated with auto-immune polyglandular syndrome (APS). The use of glucocorticosteroids predicted an abnormal test. Conclusions: By using the basal cortisol cut-off values of 145 nmol/L and 375 nmol/L, the number of performed outpatient LD-SST’s can be reduced by 12%, maintaining high sensitivity and specificity. The outcome of the LD-SST was predicted by chronic fatigue symptoms, hypotension/ orthostasis symptoms, the use of glucocorticosteroids and APS-associated autoimmune diseases. When central adrenal insufficiency is suspected, the use of inhaled, oral and nasal glucocorticosteroids and also suspected hypopituitary pathology are predictive variables.
| Item Type: | Thesis (Thesis) |
|---|---|
| Supervisor name: | begeleider: and Mijnhout, dr. G.S. and Interne Geneeskunde, Isala Klinieken |
| Faculty: | Medical Sciences |
| Keywords: | HBO-V |
| Date Deposited: | 25 Jun 2020 10:49 |
| Last Modified: | 25 Jun 2020 10:49 |
| URI: | https://umcg.studenttheses.ub.rug.nl/id/eprint/1009 |
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