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CPE-008 · Classification
AI-06: Primary pattern
Primary pattern. Evaluates low cortisol (8 am below 15 µg/dL, or stimulated peak below 18).
Active rulePriority 3Adrenal engine v1.0.0
Condition
- low cortisol (8 am < 15 µg/dL, or stimulated peak < 18)
- ACTH above the laboratory upper limit
Supportive, not required
- renin raised
- aldosterone low
- hyperkalemia
What it reports
- Pattern of primary adrenal insufficiency
Recommended next steps (for physician review)
- Add renin and aldosterone to define mineralocorticoid deficiency
- Look for the cause: 21-hydroxylase antibodies, then adrenal imaging
Diagnostic boundary
- A pattern for physician review.
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
Cases where this rule fires
Open a case to see this rule fire with real inputs, then change the values until it stops.
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