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CPE-008 · Testing
AI-04: Morning cortisol band
Morning cortisol band. Evaluates 8 am total cortisol entered.
Condition
- 8 am total cortisol entered
What it reports
- Below 5 µg/dL: adrenal insufficiency very likely
- 5 to under 15 µg/dL: indeterminate, needs an ACTH-stimulation test
- 15 µg/dL or above: adrenal insufficiency unlikely
Diagnostic boundary
- Assay-dependent; acute illness can alter the bands.
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-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.
ADR-FX-07
Stimulated peak cortisol of 11 µg/dL
Insufficient response.
ADR-FX-08
Cortisol 3.0 with ACTH 5, after head trauma
A secondary pattern.
ADR-FX-16
Cortisol 8 µg/dL drawn at 2 pm
Afternoon sample.
ADR-FX-17
Cortisol 14 on an oral contraceptive
Binding globulin raises total cortisol.
ADR-FX-18
Cortisol 3.5, ACTH missing
The axis cannot be classified.
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