Clinical inquiries. What's the most practical way to rule out adrenal insufficiency?
A morning serum cortisol level >13 mcg/dL reliably rules out adrenal insufficiency, and the test is easy and safe to perform. Because of low specificity, patients with a level of < or =13 mcg/dL need further evaluation with the cosyntropin stimulation test (CST). The 250 mcg CST requires intravenous (IV) or intramuscular (IM) administration of cosyntropin and multiple blood draws; a normal response reliably rules out primary adrenal insufficiency and moderately decreases the likelihood of secondary adrenal insufficiency. The 1 mcg CST has better diagnostic discrimination, but requires an extra step to dilute the cosyntropin.
University of Minnesota/St. Cloud Hospital Family Medicine Residency, St. Cloud, MN USA.
Thomas J
TJ
Satre
Fran
F
Kovach
D000309:Adrenal Insufficiency / Q000175:diagnosis*; D003366:Cosyntropin; D006728:Hormones; D006801:Humans; D006854:Hydrocortisone / Q000097:blood
D006728:Hormones; D003366:Cosyntropin; D006854:Hydrocortisone