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diagnosis differential endocrinology adrenal insufficiency causes management evaluation hematology stimulation cosyntropin disease nephrology obgyn syndrome testing treatment clinical criticalcare cushings
Primary Adrenal Insufficiency: • ACTH stimulation test - Synthetic ACTH does not stimulate cortisol secretion because
stimulation test ... not stimulate cortisol ... • Serum cortisol ... stimulation test ... endocrinology #workup
Diagnosis Adrenal Insufficiency - Algorithm Step 1) Screening Test: 6-8AM Cortisol Level - Early morning cortisol levels
Insufficiency - Algorithm ... Step 1) Screening Test ... ) Confirmation Test ... This test determines ... Insufficiency #Algorithm
Adrenal Insufficiency Diagnosis Algorithm - Evaluation of HPA Axis Response to ACTH Early am cortisol < 3
Insufficiency Diagnosis Algorithm ... Axis Response to ACTH ... Standard Stim test ... Insufficiency #Diagnosis #Algorithm ... #Test #Endocrinology
Adrenal Insufficiency Differential Diagnosis Algorithm Clinical suspicion: Weakness, fatigue, nausea, musculoskeletal pain, dizziness, volume depletion, abdominal pain,
Differential Diagnosis Algorithm ... ) stimulation test ... Low Cortisol Response ... High baseline ACTH ... Differential #Diagnosis #Algorithm
Primary Adrenal Insufficiency Addison's Disease - Damage of the adrenal glands with lack of cortisol, androgens and
clue • Blood tests ... and ACTH - + ... stimulation test ... test is not affected ... test is affected
Adrenal Insufficiency Diagnosis Algorithm Clinical features: - Weight loss, anorexia, Weakness, fatigue, GI distress - Hypotension,
skin (due to high ACTH ... : - AM serum cortisol ... unlikely - If serum cortisol ... cosyntropin stimulation test ... interact with stim test
Adrenal Insufficiency Diagnosis Algorithm Test 1: Baseline AM Cortisol - Beware of major normal value -
Insufficiency Diagnosis Algorithm ... Test 1: Baseline ... AM Cortisol - ... OCPs, pregnancy) Test ... 2: ACTH Stimulation
Cushing Syndrome Testing Algorithm INDICATIONS FOR TESTING: • Suspected Cushing syndrome (central obesity, muscle weakness, refractory hypertension) Testing:
Syndrome Testing Algorithm ... dexamethasone suppression test ... Urine Free by LC-MS ... /MS) • Adrenocorticotropic ... Syndrome #diagnosis #algorithm
Adrenal Insufficiency - Diagnosis and Management Summary Primary Adrenal Insufficiency: Most Common Cause in the US: Autoimmune Adrenalitis Other
is absent (low ACTH ... A STIM test can ... ACTH STIM TEST: ... and ACTH 2. ... Measure cortisol
Adrenal Insufficiency Algorithm - Cosyntropin Stimulation Test T-1m: Baseline cortisol drawn T0: 250 µg cosyntropin given IV T30m: Repeat
Insufficiency Algorithm ... Cosyntropin Stimulation Test ... T-1m: Baseline cortisol ... IV T30m: Repeat cortisol ... Insufficiency #Testing #Algorithm
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