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



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