ABSTRACT
Objectiveâ :â To examine diagnostic performance of corticotropin-releasing hormone (CRH) test combined with baseline dehydroepiandrosterone sulfate (DHEA-S) in patients with a suspect of central adrenal insufficiency. Methodsâ :â Patients (n=215) requiring daily or intermittent hydrocortisone replacement, or no replacement were retrospectively checked with their peak cortisol after CRH test and baseline DHEA-S. Resultsâ :â None of 106 patients with the peak cortisolâ ≥â 17.5 µgâ/âdL after CRH test required replacement, and all 64 patients with the peak cortisolâ <â 10.0 µgâ/âdL required daily replacement. Among 8 patients with 10.0 µgâ/âdLâ ≤â the peak cortisolâ <â 17.5 µgâ/âdL and baseline DHEA-S below the reference range, 6 patients required daily replacement and 1 patient was under intermittent replacement. Among 37 patients with 10.0 µgâ/âdLâ ≤â the peak cortisolâ <â 17.5 µgâ/âdL and baseline DHEA-S within the reference range, 10 and 6 patients were under intermittent and daily replacement, respectively. Conclusionsâ :â No patients with the peak cortisolâ ≥â 17.5 µgâ/âdL required hydrocortisone replacement, and all patients with the peak cortisol below 10.0 µgâ/âdL required daily replacement. Careful clinical evaluation was required to determine requirement for replacement in patients with 10.0 µgâ/âdLâ ≤â the peak cortisolâ <â 17.5 µgâ/âdL even in combination with baseline DHEA-S. J. Med. Invest. 69 : 287-293, August, 2022.