Adrenal Insufficiency Diagnosis Algorithm - Evaluation of HPA Axis Response to ACTH Early am cortisol < 3 is virtually diagnostic of primary OR secondary AI; >17 rules this out - If unclear (often the case) then go to stim testing! Standard Stim test is 250 mcg of IV Cosyntropin - Measure cortisol before, 30 & 60 min after intravenous (IV) injection - If f/u cortisol is greater than 18, this indicates normal adrenal function - An inadequate response suggests EITHER primary or secondary AI Measure ACTH: - High = primary AI - Low = secondary or tertiary AI #Adrenal #Insufficiency #Diagnosis #Algorithm #ACTH #Stimulation #Test #Endocrinology
