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CPE-008 · Missing data
AI-MISS-01: ACTH needed to place the axis
ACTH needed to place the axis. Evaluates low cortisol or insufficient stimulation.
Active rulePriority 8Adrenal engine v1.0.0
Condition
- low cortisol or insufficient stimulation
- ACTH not entered
What it reports
- Primary versus secondary insufficiency cannot be separated without ACTH
Diagnostic boundary
- Names what is needed.
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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