open access

Vol 74, No 6 (2023)
Original paper
Submitted: 2023-11-20
Accepted: 2023-11-23
Published online: 2023-12-11
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The 1 μg Synacthen stimulation test in the diagnosis of secondary adrenal insufficiency in patients with Rathke’s cleft cyst and empty sella syndrome

Elżbieta Andrysiak-Mamos1, Karol Piotr Sagan1, Łukasz Zwarzany2, Wojciech Poncyljusz2, Anhelli Syrenicz1
·
Endokrynol Pol 2023;74(6).
Affiliations
  1. Department of Endocrinology, Metabolic Diseases, and Internal Diseases, Pomeranian Medical University in Szczecin, Szczecin, Poland
  2. Diagnostic Imaging and Interventional Radiology Unit, Pomeranian Medical University in Szczecin, Szczecin, Poland

open access

Vol 74, No 6 (2023)
Original Paper
Submitted: 2023-11-20
Accepted: 2023-11-23
Published online: 2023-12-11

Abstract

Introduction: Rathke’s cleft cyst (RCC) and primary empty sella syndrome (PESS) are usually incidental findings on magnetic resonance imaging (MRI) scans. In most cases, these lesions do not cause mass effect symptoms and do not require surgical intervention. In patients with RCC or PESS, it is important to exclude secondary adrenal insufficiency (SAI), which may be a life-threatening condition.

Material and methods: The incidence of SAI was assessed in patients with RCC or PESS detected by MRI, using the 1 μg Synacthen stimulation test. A total of 38 patients were analysed. Test results were linked to clinical symptoms and the type of cystic lesion.

Results: Assuming that cortisol levels < 14.6 μg/dL in Synacthen test are the criterion of SAI diagnosis, SAI was diagnosed only in 2 patients (5%). Adopting the traditional criterion of cortisol levels < 18 μg/dL, SAI would be diagnosed in 7 patients (18.4 %). Dizziness (Chi2 = 3.89; p = 0.049) and apathy (Chi2 = 3.87; p = 0.049) were significantly more frequent in the PESS group than in the RCC group.

Conclusions: The incidence of SAI in the general patient population with empty sella syndrome and Rathke’s cleft cysts is low. The 1 μg Synacthen test seems to be a valuable tool in the diagnosis of SAI among patients with RCC and PESS. Further studies are necessary to determine the sensitivity and specificity of the 1 μg Synacthen test with the standardization of test protocol and considering the cortisol level at the 20-minute timepoint. PESS patients report dizziness and apathy more frequently than RCC patients, which does not result from the disturbance of the hypothalamic-pituitary–adrenal axis, but probably from the different pathogenesis of these cystic lesions.

Abstract

Introduction: Rathke’s cleft cyst (RCC) and primary empty sella syndrome (PESS) are usually incidental findings on magnetic resonance imaging (MRI) scans. In most cases, these lesions do not cause mass effect symptoms and do not require surgical intervention. In patients with RCC or PESS, it is important to exclude secondary adrenal insufficiency (SAI), which may be a life-threatening condition.

Material and methods: The incidence of SAI was assessed in patients with RCC or PESS detected by MRI, using the 1 μg Synacthen stimulation test. A total of 38 patients were analysed. Test results were linked to clinical symptoms and the type of cystic lesion.

Results: Assuming that cortisol levels < 14.6 μg/dL in Synacthen test are the criterion of SAI diagnosis, SAI was diagnosed only in 2 patients (5%). Adopting the traditional criterion of cortisol levels < 18 μg/dL, SAI would be diagnosed in 7 patients (18.4 %). Dizziness (Chi2 = 3.89; p = 0.049) and apathy (Chi2 = 3.87; p = 0.049) were significantly more frequent in the PESS group than in the RCC group.

Conclusions: The incidence of SAI in the general patient population with empty sella syndrome and Rathke’s cleft cysts is low. The 1 μg Synacthen test seems to be a valuable tool in the diagnosis of SAI among patients with RCC and PESS. Further studies are necessary to determine the sensitivity and specificity of the 1 μg Synacthen test with the standardization of test protocol and considering the cortisol level at the 20-minute timepoint. PESS patients report dizziness and apathy more frequently than RCC patients, which does not result from the disturbance of the hypothalamic-pituitary–adrenal axis, but probably from the different pathogenesis of these cystic lesions.

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Keywords

Rathke’s cleft cyst; empty sella syndrome; adrenal insufficiency; Synacthen tes

About this article
Title

The 1 μg Synacthen stimulation test in the diagnosis of secondary adrenal insufficiency in patients with Rathke’s cleft cyst and empty sella syndrome

Journal

Endokrynologia Polska

Issue

Vol 74, No 6 (2023)

Article type

Original paper

Published online

2023-12-11

Page views

558

Article views/downloads

253

DOI

10.5603/ep.98271

Bibliographic record

Endokrynol Pol 2023;74(6).

Keywords

Rathke’s cleft cyst
empty sella syndrome
adrenal insufficiency
Synacthen tes

Authors

Elżbieta Andrysiak-Mamos
Karol Piotr Sagan
Łukasz Zwarzany
Wojciech Poncyljusz
Anhelli Syrenicz

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