Which additional tests are indicated in the workup of adrenal crisis?

Updated: Oct 11, 2018
  • Author: Kevin M Klauer, DO, EJD, FACEP; Chief Editor: Romesh Khardori, MD, PhD, FACP  more...
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Adrenocorticotropic hormone (ACTH) stimulation test

  • Note: In emergent situations, do not delay treatment of presumed adrenal insufficiency during diagnostic testing. Treatment with dexamethasone allows ACTH stimulation testing without affecting or interfering with the measurement of serum cortisol levels.

  • Obtain baseline serum cortisol and ACTH levels.

  • Administer 0.25 mg (250 mcg) of cosyntropin (synthetic ACTH) intravenously (IV) or intramuscularly (IM).

  • Repeat cortisol levels every 30 minutes (some authors recommend 60 min) and 6 hours after ACTH administration (generally not recommended).

  • Normal response is indicated when the cortisol peak exceeds 18 ug/dL in response to ACTH stimulation.

  • In adrenal insufficiency, serum cortisol levels fail to rise after ACTH administration.

Electrocardiograph (ECG): Elevated peaked T waves may indicate hyperkalemia.

24-hour urinary cortisol: Use only in nonemergent situations.

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