TY - JOUR
T1 - ACTH stimulation tests for the diagnosis of adrenal insufficiency
T2 - Systematic review and meta-analysis
AU - Ospina, Naykky Singh
AU - Nofal, Alaa Al
AU - Bancos, Irina
AU - Javed, Asma
AU - Benkhadra, Khalid
AU - Kapoor, Ekta
AU - Lteif, Aida N.
AU - Natt, Neena
AU - Murad, M. Hassan
PY - 2016/2
Y1 - 2016/2
N2 - Context: The diagnosis of adrenal insufficiency is clinically challenging and often requires ACTH stimulation tests. Objective: To determine the diagnostic accuracy of the high-(250 mcg) and low-(1 mcg) doseACTH stimulation tests in the diagnosis of adrenal insufficiency. Methods: We searched six databases through February 2014. Pairs of independent reviewers selected studies and appraised the risk of bias. Diagnostic association measures were pooled across studies using a bivariate model. Data Synthesis: For secondary adrenal insufficiency, we included 30 studies enrolling 1209 adults and 228 children. High-and low-dose ACTH stimulation tests had similar diagnostic accuracy in adults and children using different peak serum cortisol cutoffs. In general, both tests had low sensitivity and high specificity resulting in reasonable likelihood ratios for a positive test (adults: high dose, 9.1; low dose, 5.9; children: high dose, 43.5; low dose, 7.7), but a fairly suboptimal likelihood ratio for a negative test (adults: high dose, 0.39; low dose, 0.19; children: high dose, 0.65; low dose, 0.34). For primary adrenal insufficiency, we included five studies enrolling 100 patients. Data were only available to estimate the sensitivity of high dose ACTH stimulation test (92%; 95% confidence interval, 81-97%). Conclusion: Both high-and low-dose ACTH stimulation tests had similar diagnostic accuracy. Both tests are adequate to rule in, but not rule out, secondary adrenal insufficiency. Our confidence in these estimates islowtomoderatebecause of the likely risk of bias, heterogeneity,andimprecision.
AB - Context: The diagnosis of adrenal insufficiency is clinically challenging and often requires ACTH stimulation tests. Objective: To determine the diagnostic accuracy of the high-(250 mcg) and low-(1 mcg) doseACTH stimulation tests in the diagnosis of adrenal insufficiency. Methods: We searched six databases through February 2014. Pairs of independent reviewers selected studies and appraised the risk of bias. Diagnostic association measures were pooled across studies using a bivariate model. Data Synthesis: For secondary adrenal insufficiency, we included 30 studies enrolling 1209 adults and 228 children. High-and low-dose ACTH stimulation tests had similar diagnostic accuracy in adults and children using different peak serum cortisol cutoffs. In general, both tests had low sensitivity and high specificity resulting in reasonable likelihood ratios for a positive test (adults: high dose, 9.1; low dose, 5.9; children: high dose, 43.5; low dose, 7.7), but a fairly suboptimal likelihood ratio for a negative test (adults: high dose, 0.39; low dose, 0.19; children: high dose, 0.65; low dose, 0.34). For primary adrenal insufficiency, we included five studies enrolling 100 patients. Data were only available to estimate the sensitivity of high dose ACTH stimulation test (92%; 95% confidence interval, 81-97%). Conclusion: Both high-and low-dose ACTH stimulation tests had similar diagnostic accuracy. Both tests are adequate to rule in, but not rule out, secondary adrenal insufficiency. Our confidence in these estimates islowtomoderatebecause of the likely risk of bias, heterogeneity,andimprecision.
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U2 - 10.1210/jc.2015-1700
DO - 10.1210/jc.2015-1700
M3 - Article
C2 - 26649617
AN - SCOPUS:84959387728
SN - 0021-972X
VL - 101
SP - 427
EP - 434
JO - Journal of Clinical Endocrinology and Metabolism
JF - Journal of Clinical Endocrinology and Metabolism
IS - 2
ER -