| Studies | N | Risk of bias | Inconsistency | Indirectness | Imprecision | Effect size (95%CI) | Quality |
|---|---|---|---|---|---|---|---|
| Nausea and vomiting for diagnosing adrenal insufficiency (8am cortisol level of <3 μg/dL or a peak serum cortisol level of <18 μg/dL after a 5 μg ACTH stimulation test) in people using topical corticosteroids for at least 12 months | |||||||
| 1 cross sectional study | 42 | Very Seriousa | Not serious | Very seriousb | Not serious | Sensitivity=0.00 (0.00–0.20) | VERY LOW |
| Very Seriousa | Not serious | Very seriousb | Not serious | Specificity=1.00 (0.86–1.00) | VERY LOW | ||
Risk of bias was assessed using the QUADAS-2 checklist. The evidence was downgraded by 2 increments due to very high risk of bias (unclear patient selection, unclear application of the reference standard (unclear if blinded) and unclear timing between index test and reference standard).
The evidence was downgraded by 2 increments due to very serious indirectness (serious population indirectness due to concerns over applicability of evidence from topical steroid use population to general population; serious indirectness of the reference standard due to concerns over applicability of evidence on low dose ACTH test).
From: When to suspect adrenal insufficiency
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