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Can a Short Synacthen identify Secondary Adrenal Insufficiency?

Hi All,

Can the Short Synacthen Test diagnose (SST) Secondary Adrenal Insufficiency?

The test entails administration of an ACTH bio-similar agent to stimulate the Adrenal Glands to produce Cortisol then blood tests are taken at 30 and 60 minutes post administration however surely this will only identify issues with Adrenal and not the ACTH producing cells in the Pituitary Gland - am I right in my understanding?

Plasma Bloods for ACTH are unhelpful as the health of these aforementioned glands can only be identified if the bods is under stress as essentially we are testing their response to stress.

I'm Hypopit and my SST confirmed I was low normal which suggests there is problems with my adrenals despite being within reference ranges so not 'clinically sufficient' however as I'm Hypopit, shouldn't my Endo have conducted an Insulin Tolerance Test to rule out Secondary Adrenal Insufficiency?

I would appreciate your comments.


4 Replies

This test needs to be done as early as possible in the day. I had to wait till half way through the day! My doctor said the tests almost always came back negative, I explained that was because doctors couldn't tell the difference betwee adrenal FATIGUE and adrenal FAILURE!


Hello Tom,

I would say from personal experience (and also what I have read in my wonderful Thyroid books and this site) that the Synacthen Test is useless, it will only pick up Cushings Disease or Addisons Disease.

I had the Synacthen test done - it came back negative, approx 2 weeks letter I had the ASI Test done ( Privately, Recommended by Dr Peatfield) and it was clear the adrenals were a real problem.


I had the Insulin Stress test - came back normal even though on the way out of the hospital I collapsed on the ground with raging headache, stomach pains and vomiting. I obviously didn't collapse soon enough - within their time limit - must be a slow responder ;-) So don't get your hopes up! It's usually Short synacthen first, then Insulin stress test.


Leeds teaching hospital trust Web site inform Short Synacthen Test is not reliable for SAI


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