ArticleAACE endocrinology and diabetes
Newer Generation Immunoassays in Screening for Adrenal Insufficiency: Comparison of Baseline Morning Cortisol Levels With Cosyntropin Stimulation Testing.
Article in AACE endocrinology and diabetes. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Not yet cited in PubMed.
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Abstract
Objective: Serum cortisol immunoassays with improved specificity for cortisol have prompted revisiting the definition of a normal response at 60-minute cosyntropin stimulation testing (CST-60) to ≥14 μg/dL. European and American Endocrine Societies define values of AM cortisol >10 μg/dL as adequate to rule out adrenal insufficiency (AI) in patients with long-term use of corticosteroids. We sought to compare AM cortisol levels with CST-60 in patients suspected of AI from various causes. Methods: A retrospective review was performed from the electronic health record of a large midwestern hospital in patients who were evaluated for AI. Results: There were 95 patients (51women, age 58.8 ± 17.8 SD years) with 43 tests performed outpatient, 48 inpatient, and 4 ICU settings. The pretest diagnoses were adrenal abnormalities ( Conclusion: In this community setting with low risk of AI (16%), a baseline AM cortisol of 11.1 μg/dL can reliably preclude the need for a CST-60. Clinicians should be aware of the new cutoffs for the assays available to them when evaluating patients for AI.
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