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CPE-008 · Screening
AI-01: Clinical and laboratory pattern that justifies testing
Clinical and laboratory pattern that justifies testing. Evaluates laboratory features: sodium below 135, potassium above 5.0, eosinophils above 5%, glucose below 70.
Condition
- laboratory features: sodium < 135, potassium > 5.0, eosinophils > 5%, glucose < 70
- clinical features: fatigue, weight loss, nausea or vomiting, orthostatic dizziness, hyperpigmentation, salt craving
- at least one of each, OR three of any
What it reports
- Screening opportunity: measure an 8 am cortisol with ACTH
Recommended next steps (for physician review)
- Order an 8 am cortisol with ACTH; add renin and aldosterone when primary insufficiency is suspected
Diagnostic boundary
- Individually non-specific features; the pattern only justifies measuring.
Evidence
- EV-ES-PAI-2016Bornstein 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.Supports: Morning cortisol and ACTH as first tests; ACTH stimulation with 250 µg cosyntropin; peak cortisol below 18 µg/dL as insufficient Suspected adrenal crisis must be treated without waiting for tests
- EV-HUSEBYE-2014Husebye ES, Allolio B, Arlt W, et al. Consensus statement on the diagnosis, treatment and follow-up of patients with primary adrenal insufficiency. J Intern Med. 2014;275(2):104-115.Supports: Morning cortisol below about 5 µg/dL makes insufficiency very likely, above about 15 µg/dL unlikely
Cases where this rule fires
Open a case to see this rule fire with real inputs, then change the values until it stops.
ADR-FX-01
Low sodium, high potassium, weight loss and nausea
A 44-year-old with hyperpigmented scars.
ADR-FX-03
Salt craving and dizziness on standing
Low sodium.
ADR-FX-11
Checkpoint inhibitor, headache and sodium 129
An immune-related adverse event to look for.
ADR-FX-12
Blood pressure 78/40, known adrenal insufficiency, vomiting
A possible adrenal crisis.
ADR-FX-19
Potassium 6.4, sodium 126 and hyperpigmentation
Severe metabolic derangement.
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