![]() ![]() In this situation, the administration of supraphysiologic synthetic corticotropin may stimulate the adrenal cortex enough to mount a cortisol response above the cutoff considered diagnostic (18-20 μg/dL). ![]() This factor may explain the suboptimal performance of the test. However, the onset of OIAI is unknown, and some background corticotropin may be present (partial secondary adrenal insufficiency) depending on the dose, duration, and individual susceptibility to opiates. The CST is reliant on adrenal cortex atrophy, which occurs in primary adrenal insufficiency or prolonged absence of corticotropin. Sensitivity of the 250-μg CST in secondary adrenal insufficiency is suboptimal (64% 95% CI, 52%-73%), with a likelihood ratio for a negative result being only 0.39 (0.3-0.52). ![]()
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