Berna EROĞLU FİLİBELİ, Gülümay VURAL TOPAKTAŞ, Bumin N. DÜNDAR
Forbes Tıp Dergisi - 2026;7(1):69-74
Objective: The low-dose adrenocorticotropic hormone stimulation test (LDAT) is widely used to evaluate the hypothalamic-pituitary-adrenal axis in pediatric endocrinology, particularly in suspected central adrenal insufficiency. This study aimed to retrospectively evaluate the clinical characteristics, indications, and outcomes of LDAT in a tertiary pediatric endocrinology center. Methods: This retrospective study included 120 pediatric patients who underwent LDAT. A peak serum cortisol level >=18 µg/dL at 30 minutes was considered an adequate adrenal response. Demographic, clinical, and laboratory data were analyzed. Receiver operating characteristic (ROC) analysis was performed to assess the diagnostic performance of baseline cortisol levels. Results: A total of 120 patients (61 females, 59 males) were included. The median age was 11.5 years (interquartile range: 5.6); 55.8% were pubertal. The most common indication for testing was suspected central hypothyroidism (30.8%), followed by short stature or growth hormone deficiency (27.5%), and intracranial lesions or malformations (21.7%). An insufficient cortisol response was observed in 24.2% of patients. No significant differences were found between patients with adequate and insufficient responses regarding age, sex, anthropometric characteristics, or test indications (p>0.05). Baseline cortisol levels were significantly higher in patients with adequate responses (9.02+/-3.73 vs. 5.33+/-3.94 µg/dL, p<0.001). ROC analysis showed moderate diagnostic performance (area under the curve =0.75): a cut-off value of 5.05 µg/dL yielded 86.8% sensitivity and 55.2% specificity. None of the patients with baseline cortisol >13 µg/dL had an insufficient response. Conclusion: LDAT remains a practical tool for evaluating adrenal function in children. Baseline cortisol may help identify low-risk patients, but dynamic testing remains essential for definitive diagnosis.
