Dutch Complete with Cortisol Awakening Response vs Short Synacthen Test

[rachelleigh]

Hi - I'm just wondering if there is any comparison between these two tests. I have suspected secondary hypothyroidism and have been referred for the SST within the NHS but have recently taken a private Dutch Complete with CAR. Does the private test cover the same data as the NHS test? Can the results be used instead of the SST - or is the SST still necessary? Many thanks!

[MaisieGray]

I don't think there's any comparison. The short Synacthen test is a simple cause and effect test of adrenal insufficiency based on the measurement of serum cortisol before and after an injection of synthetic ACTH. The Dutch Complete, as the marketing blurb says, "offers the most extensive profile of sex and adrenal hormones along with their metabolites. Additionally, the daily (diurnal) pattern of free cortisol is included, along with melatonin (6-OHMS), 8-OHdG, and six organic acids" and the CAR provides "Analysis of cortisol awakening response from cortisone and cortisol". You would have to ask your NHS Consultant if he's willing to accept/act on your DUTCH results.

[rachelleigh73 in reply to MaisieGray]

Thanks Maisie - I appreciate your reply. I understand the differences between the two tests - I guess what I'm not clear about is if the Dutch test will be relevant to the NHS. I'm expecting the SST to come back as 'normal'- I don't believe that I have Addisons, but I do suspect that my adrenals aren't as strong as they should be. I think I'm right in that the NHS is only looking for Addison's with the SST - that it doesn't help with the bigger picture? I have a 9am serum cortisol result of 190 which prompted the NHS referral. Thanks again x

[MaisieGray in reply to rachelleigh73]

Yes, SST is a useful test of adrenal (in)sufficiency, and where it's suspected that the pituitary gland isn't producing enough ACTH; but narrowly specific - when artificially prompted by synthetic ACTH, is cortisol produced, and is it within normal amounts for that time of day. So it measures cortisol produced, but isn't reflecting any changes, peaks or troughs, happening throughout the 24 hr cycle, nor as is the case with urine testing, what level is free, ie unbound from its carrier, and therefore available. As I mentioned, whether your GP/Endo accepts or is dismissive of your DUTCH test, will be down to them - some GPs can't even grasp the concept that a simple blood test carried out privately is as valid as that ordered by them, and may even be carried out in the same labs. The added problem is that adrenal fatigue isn't generally recognised medically; plus I don't know how universally well known and/or accepted, the DUTCH test is. You can only offer to share your results and see what is the response, but I'd certainly have the SST in any case, to avoid being seen as non-compliant, which tends not to go down too well.

[rachelleigh73 in reply to MaisieGray]

Brilliant - thanks again Maisie for your input - much appreciated!