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The cortisol reponses have lowered with time due to assay changes. ~15 years ago Prof Paul Stewart took a cohort of healthy individuals and ran through 5 immunoassays at that stage. There was great variability between the methods. Having been involved in a large cohort on inhaled steroids where we performed low dose short synacthen tests, the current Abbott Architect cut -off is 450 nmol/l in children. Audit data suggests 480 nmol/l in adults, but then there are slight differences if female esp on pill The same is worse with a cut off with Growth Hormone even in ITTs. This is compounded by our knowledge of EQA where a sample around the classsical GH cutoff has a SD of 12.5% in the schemes Cut-offs aren't clear cut, they need to be interpreted with the patient in mind Peter From: Clinical biochemistry discussion list [mailto:[log in to unmask]] On Behalf Of David James Sent: 05 February 2015 11:35 To: [log in to unmask] Subject: Re: Short Synacthen More interestingly - does anyone know what method was used when these were first established and entered our text books, and how that method compares with modern methods......................which if you look at how they all differ for measuringthe same white compound :) dj From: Clinical biochemistry discussion list [mailto:[log in to unmask]] On Behalf Of Colley, Michael Sent: 05 February 2015 11:32 To: [log in to unmask] Subject: Short Synacthen We were discussing Short Synacthen testing a few days ago, especially in the light of the paper comparing responses and measuring by GCMS and 5 different immunoassays El-Erhan et al., Clinical Endocrinology (2013) 78, 673-680 which suggests that currently used cut-offs (550 - 580) may be misclassifying some normal people as deficient. Our endocrinologists are suggesting decreasing the cut-off level. What cortisol levels do you take as adequate basal and stimulated response, and on what equipment are you measuring it? I'm happy to collate responses. Many Thanks Michael Dr. C . M. Colley Consultant Chemical Pathologist Great Western Hospital Swindon SN3 6BB ________________________________ Great Western Hospitals NHS Foundation Trust Great Western Hospital Marlborough Road Swindon SN3 6BB Tel 01793 60 40 20 http://www.gwh.nhs.uk Register to become a member of the Trust at https://members.gwh.nhs.uk This message and any files transmitted with it are confidential and intended solely for the individual(s) addressed. If you believe you have received this e-mail in error, disclosing, copying, distributing or retaining this message, or any part of it, is strictly prohibited; please notify the sender immediately and delete it from your system. 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