What are the limitations of the short synacthen test interpreter?

While the short synacthen test interpreter is highly validated, it should not replace clinical judgment. OpiCalc provides the latest evidence-based limitations for the short synacthen test interpreter to ensure safe bedside use and optimal diagnostic accuracy.

How does the short synacthen test interpreter compare to other Endocrinology scores?

The short synacthen test interpreter is a gold-standard diagnostic tool. OpiCalc provides side-by-side clinical guidance to help clinicians choose the most specific evidence-based tool for their patient's presentation.

Is the short synacthen test interpreter free to use?

Yes. OpiCalc provides the short synacthen test interpreter completely ad-free and optimized for mobile bedside use, ensuring you can calculate medical risk swiftly and without distraction.

Short synacthen test interpreter | Endocrinology Calculator

CLINICAL REFERENCE

CLINICAL INSIGHT

When to Use

Diagnosis of Primary Adrenal Insufficiency (Addison's Disease).
Diagnosis of chronic Secondary Adrenal Insufficiency.
Evaluating suspected Non-Classic Congenital Adrenal Hyperplasia (screen via 17-OHP response).
Determining requirement for perioperative steroid cover in steroid-dependent patients.

CLINICAL INSIGHT

How it Works

Standard SST Procedure

Baseline: Draw cortisol (T=0).
Injection: Administer 250 mcg of Cosyntropin (Synacthen) IV or IM.
Stimulation: Draw cortisol at 30 minutes and/or 60 minutes.
Interpretation: Peak cortisol ≥ 18 mcg/dL (500 nmol/L) excludes adrenal insufficiency in most cases.

CLINICAL INSIGHT

Practical Pearls

Assay Matters

The traditional "pass" threshold of 18 mcg/dL (500 nmol/L) was based on older polyclonal cortisol assays. Modern monoclonal (LC-MS/MS) assays are more specific and often have lower peak thresholds (e.g., 14–15 mcg/dL). Clinicians should refer to lab-specific reference ranges.

The Pituitary Caveat

A "Normal" SST does NOT exclude secondary adrenal insufficiency if the insult happened in the last 4 weeks. If pituitary surgery or trauma has just occurred, the adrenal glands are still "charged" and will respond to Synacthen even if the ACTH drive is gone. Wait at least 4-6 weeks for adrenal atrophy to occur before relying on the SST.

CLINICAL INSIGHT

Evidence Base

Primary Source

Diagnosis and Treatment of Primary Adrenal Insufficiency: An Endocrine Society Clinical Practice Guideline.

Bornstein SR, et al.J Clin Endocrinol Metab2016

When to Use

When to Use

How it Works

Standard SST Procedure

Practical Pearls

Assay Matters

The Pituitary Caveat

Evidence Base

Primary Source

Short Synacthen Test Interpreter

When to Use

When to Use

How it Works

Standard SST Procedure

Practical Pearls

Assay Matters

The Pituitary Caveat

Evidence Base

Primary Source

Short Synacthen Test Interpreter

Clinical Evidence and Methodology

When to Use

When to Use

How it Works

Standard SST Procedure

Practical Pearls

Assay Matters

The Pituitary Caveat

Evidence Base

Primary Source

Short Synacthen Test Interpreter

Clinical Evidence and Methodology

When to Use

When to Use

How it Works

Standard SST Procedure

Practical Pearls

Assay Matters

The Pituitary Caveat

Evidence Base

Primary Source

Short Synacthen Test Interpreter