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CPE-008 · synthetic case ADR-FX-24
Normal stimulation test
Peak cortisol 22 µg/dL.
Purpose: Peak cortisol 22 µg/dL.
Inputs the engine received
Cortisol testing
- Peak cortisol after 250 µg cosyntropin
- 22 µg/dL
Chemistry and vitals
- Age
- 42 years
Symptoms and signs
- Fatigue
- Yes
What the engine reports
Detected clinical pattern
Adrenal Insufficiency Unlikely From the Cortisol Entered
The cortisol result makes adrenal insufficiency unlikely. If clinical suspicion persists, a stimulation test can still be considered.
Why this pattern was identified
- ACTH-stimulation test. Peak 22 µg/dL is adequate, although recent-onset secondary insufficiency can still pass.
Evidence and rule trace · 1 rules
Evidence
- EV-ES-PAI-2016 · Bornstein SR, Allolio B, Arlt W, et al. Diagnosis and Treatment of Primary Adrenal Insufficiency: An Endocrine Society Clinical Practice Guideline. J Clin Endocrinol Metab. 2016;101(2):364-389.
Physician adjudication required. Clinical decision support for physician review. This output identifies laboratory patterns and safety situations. It does not diagnose adrenal insufficiency, name a glucocorticoid dose, or replace emergency treatment. Physician adjudication is required.
Change the values
The same engine, starting from this case. Change any value and watch the pattern and the rule trace react.
Cortisol testing
- <5 very likely
- 5–14.9 indeterminate
- ≥15 unlikely
46 pg/mL is assumed when empty.
Chemistry and vitals
Symptoms and signs
Exposures, history and context
More adrenal cases
ADR-FX-01
Low sodium, high potassium, weight loss and nausea
A 44-year-old with hyperpigmented scars.
ADR-FX-02
Hyperpigmentation and fatigue
No labs yet.
ADR-FX-03
Salt craving and dizziness on standing
Low sodium.
ADR-FX-04
Cortisol 2.1 with ACTH 180
Low cortisol and high ACTH: a primary pattern.
ADR-FX-05
Morning cortisol 9 µg/dL
Indeterminate.
ADR-FX-06
Morning cortisol 17 µg/dL
Unlikely.
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