Lack of sensitivity of the 1-μg low-dose ACTH stimulation test in a paediatric population with suboptimal cortisol responses to insulin-induced hypoglycaemia

Summary Context The insulin‐tolerance test (ITT) is the gold standard for evaluation of the hypothalamic‐pituitary‐adrenal (HPA) axis. The low‐dose ACTH stimulation test is increasingly used for evaluation of secondary adrenal insufficiency as several studies performed in adults have demonstrated high sensitivity and specificity when compared to the ITT. Whether the ACTH stimulation test demonstrates similar sensitivity in a paediatric and adolescent population compared with the gold standard is unclear. Objective To compare the sensitivity of the low‐dose (1‐μg) Synacthen™ test (LDSST) and the gold‐standard ITT in a paediatric and adolescent population. Design and Patients A retrospective review of 42 consecutive LDSSTs in children and adolescents with suboptimal cortisol responses (peak