{'fraction_non_alphanumeric': 0.025748086290883786, 'fraction_numerical': 0.025052192066805846, 'mean_word_length': 4.845528455284553, 'pattern_counts': {'":': 0, '<': 0, '<?xml version=': 0, '>': 0, 'https://': 0, 'lorem ipsum': 0, 'www.': 0, 'xml': 0}, 'pii_count': 0, 'substrings_counts': 0, 'word_list_counts': {'cursed_substrings.json': 0, 'profanity_word_list.json': 0, 'sexual_word_list.json': 0, 'zh_pornsignals.json': 0}}
Diagnosing adrenal insufficiency: which test is best--the 1-microg or the 250-microg cosyntropin stimulation test?

OBJECTIVE
To review the available literature on the low-dose cosyntropin stimulation test (CST) for the diagnosis of primary and secondary adrenal insufficiency in both nonstressed and acutely ill patients.


METHODS
We performed a MEDLINE search of all English-language literature, published between 1965 and 2007, in which the 1-microg and the 250-microg CSTs were compared in patients with primary and secondary adrenal insufficiency.


RESULTS
The majority of published evidence suggests that the 1-microg CST is more sensitive than the 250-microg CST for the diagnosis of secondary adrenal insufficiency in nonstressed patients. In patients with primary adrenal insufficiency, the low-dose CST is unlikely to add any diagnostic sensitivity to the high-dose CST. In critically ill patients, the 1-microg test is also likely to be more sensitive than the 250-microg test when an appropriate cutoff value is used (25 microg/dL).


CONCLUSION
The 1-microg CST with a cortisol level determined at 30 minutes after stimulation, with use of a cutoff level of 18 to 20 microg/dL in nonstressed patients and less than 25 microg/dL or an increment of less than 9 microg/dL from baseline in critically ill patients, is the best test that is currently available for establishing the diagnosis of secondary adrenal insufficiency.