How is
adrenal reserve evaluated?
The most commonly performed outpatient test for
adrenal reserve is a urinary free cortisol collection over 24 hours. For
hospitalized patients, the ACTH stimulation test is most commonly performed to
determine the pres-ence of adequate adrenal function. This screening test
entails the measurement of a baseline plasma cortisol, fol-lowed by a
measurement at 30 and 60 minutes after the intravenous administration of 250 μg of cosyntropin, an ACTH analog. During periods of stress, the
baseline plasma cortisol level should exceed 20 μg/dL and all patients should have a rise in
their plasma cortisol level of at least 7 μg/dL above their baseline.
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