Corticotropin tests for hypothalamic-pituitary-adrenal insufficiency: A metaanalysis

Rasa Kazlauskaite, Arthur T. Evans, Carmen V. Villabona, Tariq A M Abdu, Bruno Ambrosi, A. Brew Atkinson, Hei Choi Cheung, Richard N. Clayton, C. Hamish Courtney, E. Nazli Gonc, Mohamad Maghnie, Susan R. Rose, Steven G. Soule, Karen Tordjman

Research output: Contribution to journalArticle

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Abstract

Context: The diagnostic value of tests for detecting hypothalamic-pituitary adrenal insufficiency (HPAI) is controversial. Objective: Our objective was to compare standard-dose and low-dose corticotropin tests for diagnosing HPAI. Data Sources: We searched the PubMed database from 1966-2006 for studies reporting diagnostic value of standard-dose or low-dose corticotropin tests, with patient-level data obtained from original investigators. Study Selection: Eligible studies had more than 10 patients. All subjects were evaluated because of suspicion for chronic HPAI, and patient-level data were available. We excluded studies with no accepted reference standard for HPAI (insulin hypoglycemia or metyrapone test) if test subjects were in the intensive care unit or if only normal healthy subjects were used as controls. Data Extraction: We constructed receiver operator characteristic (ROC) curves using patient-level data from each study and then merged results to create summary ROC curves, adjusting for study size and cortisol assay method. Diagnostic value of tests was measured by calculating area under the ROC curve (AUC) and likelihood ratios. Data Synthesis: Patient-level data from 13 of 23 studies (57%; 679 subjects) were included in the metaanalysis. The AUC were as follows: low-dose corticotropin test, 0.92 (95% confidence interval 0.89-0.94), and standard-dose corticotropin test, 0.79 (95% confidence interval 0.74-0.84). Among patients with paired data (seven studies, 254 subjects), diagnostic value of low-dose corticotropin test was superior to standard-dose test (AUC 0.94 and 0.85, respectively; P <0.001). Conclusions: Low-dose corticotropin test was superior to standard-dose test for diagnosing chronic HPAI, although it has technical limitations.

Original languageEnglish
Pages (from-to)4245-4253
Number of pages9
JournalJournal of Clinical Endocrinology and Metabolism
Volume93
Issue number11
DOIs
Publication statusPublished - Nov 2008

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Adrenal Insufficiency
Hypopituitarism
Adrenocorticotropic Hormone
Routine Diagnostic Tests
ROC Curve
Area Under Curve
Confidence Intervals
Metyrapone
Intensive care units
Information Storage and Retrieval
Hypoglycemia
PubMed
Intensive Care Units
Hydrocortisone
Assays
Healthy Volunteers
Research Personnel
Databases
Insulin

ASJC Scopus subject areas

  • Biochemistry
  • Clinical Biochemistry
  • Endocrinology
  • Biochemistry, medical
  • Endocrinology, Diabetes and Metabolism

Cite this

Kazlauskaite, R., Evans, A. T., Villabona, C. V., Abdu, T. A. M., Ambrosi, B., Atkinson, A. B., ... Tordjman, K. (2008). Corticotropin tests for hypothalamic-pituitary-adrenal insufficiency: A metaanalysis. Journal of Clinical Endocrinology and Metabolism, 93(11), 4245-4253. https://doi.org/10.1210/jc.2008-0710

Corticotropin tests for hypothalamic-pituitary-adrenal insufficiency : A metaanalysis. / Kazlauskaite, Rasa; Evans, Arthur T.; Villabona, Carmen V.; Abdu, Tariq A M; Ambrosi, Bruno; Atkinson, A. Brew; Cheung, Hei Choi; Clayton, Richard N.; Courtney, C. Hamish; Gonc, E. Nazli; Maghnie, Mohamad; Rose, Susan R.; Soule, Steven G.; Tordjman, Karen.

In: Journal of Clinical Endocrinology and Metabolism, Vol. 93, No. 11, 11.2008, p. 4245-4253.

Research output: Contribution to journalArticle

Kazlauskaite, R, Evans, AT, Villabona, CV, Abdu, TAM, Ambrosi, B, Atkinson, AB, Cheung, HC, Clayton, RN, Courtney, CH, Gonc, EN, Maghnie, M, Rose, SR, Soule, SG & Tordjman, K 2008, 'Corticotropin tests for hypothalamic-pituitary-adrenal insufficiency: A metaanalysis', Journal of Clinical Endocrinology and Metabolism, vol. 93, no. 11, pp. 4245-4253. https://doi.org/10.1210/jc.2008-0710
Kazlauskaite, Rasa ; Evans, Arthur T. ; Villabona, Carmen V. ; Abdu, Tariq A M ; Ambrosi, Bruno ; Atkinson, A. Brew ; Cheung, Hei Choi ; Clayton, Richard N. ; Courtney, C. Hamish ; Gonc, E. Nazli ; Maghnie, Mohamad ; Rose, Susan R. ; Soule, Steven G. ; Tordjman, Karen. / Corticotropin tests for hypothalamic-pituitary-adrenal insufficiency : A metaanalysis. In: Journal of Clinical Endocrinology and Metabolism. 2008 ; Vol. 93, No. 11. pp. 4245-4253.
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