Journal of the Endocrine Society
Oxford University Press
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MON-136 Reducing Unnecessary Inpatient Adrenocorticotropin Stimulation Tests
Volume: 4, Issue: Suppl 1
DOI 10.1210/jendso/bvaa046.1372

Highlights

Notes

Abstract

Background:

Outpatient adrenocorticotropin (ACTH) stimulation tests can be challenging to interpret due to heterogeneously reported cut-offs. Inpatient stimulation tests present additional challenges due to the presence of acute illness and unreliable coordination of dynamic function testing on a busy inpatient service. This study aims to characterize the use of ACTH stimulation tests in hospitalized patients to determine necessity of testing.

Methods:

We conducted an inpatient audit of ACTH simulation tests done to rule out adrenal insufficiency between April 2018 to March 2019 at our institution. Normal post-ACTH response was defined as peak cortisol ≥500 nmol/L. Testing was considered inappropriate in patients with normal post-ACTH response who had a serum cortisol ≥250 nmol/L drawn during the same admission prior to stimulation testing. Cut-offs were based on previous analysis of 195 outpatient stimulation tests.

Results:

During the one-year study period there were 40 inpatients who had an ACTH stimulation test. Nineteen (48%) were considered unnecessary because patients either had a pre-ACTH serum cortisol ≥250 nmol/L and/or a 0-minute cortisol value just prior to the ACTH stimulation test ≥250 nmol/L. Except for a single instance where the patient was inappropriately on prednisone when basal cortisol was tested, all patients with any pre-ACTH cortisol ≥250 nmol/L had a normal post-ACTH response

Conclusion:

Institutions may avoid unnecessary inpatient ACTH stimulation tests by implementing protocols which ensure that basal cortisol levels are drawn and below locally determined cut-offs before proceeding to dynamic testing. To characterize further, a three-year analysis of inpatient ACTH stimulation tests is underway.

Ali, Lochnan, Shaw, and Tran: MON-136 Reducing Unnecessary Inpatient Adrenocorticotropin Stimulation Tests
https://www.researchpad.co/tools/openurl?pubtype=article&doi=10.1210/jendso/bvaa046.1372&title=MON-136 Reducing Unnecessary Inpatient Adrenocorticotropin Stimulation Tests&author=Ridha Ali,Heather Anne Lochnan,Julie Shaw,Christopher S Tran,&keyword=&subject=Healthcare Delivery and Education,Expanding Clinical Considerations for Patient Testing and Care,AcademicSubjects/MED00250,