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  • Title: Diagnosing adrenal insufficiency: which test is best--the 1-microg or the 250-microg cosyntropin stimulation test?
    Author: Magnotti M, Shimshi M.
    Journal: Endocr Pract; 2008 Mar; 14(2):233-8. PubMed ID: 18308665.
    Abstract:
    OBJECTIVE: To review the available literature on the low-dose cosyntropin stimulation test (CST) for the diagnosis of primary and secondary adrenal insufficiency in both nonstressed and acutely ill patients. METHODS: We performed a MEDLINE search of all English-language literature, published between 1965 and 2007, in which the 1-microg and the 250-microg CSTs were compared in patients with primary and secondary adrenal insufficiency. RESULTS: The majority of published evidence suggests that the 1-microg CST is more sensitive than the 250-microg CST for the diagnosis of secondary adrenal insufficiency in nonstressed patients. In patients with primary adrenal insufficiency, the low-dose CST is unlikely to add any diagnostic sensitivity to the high-dose CST. In critically ill patients, the 1-microg test is also likely to be more sensitive than the 250-microg test when an appropriate cutoff value is used (25 microg/dL). CONCLUSION: The 1-microg CST with a cortisol level determined at 30 minutes after stimulation, with use of a cutoff level of 18 to 20 microg/dL in nonstressed patients and less than 25 microg/dL or an increment of less than 9 microg/dL from baseline in critically ill patients, is the best test that is currently available for establishing the diagnosis of secondary adrenal insufficiency.
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