Review: The cosyntropin-stimulation test has limited value for detecting and excluding adrenal insufficiency: COMMENTARY

Montori, Victor M.
January 2004
ACP Journal Club;Jan/Feb2004, Vol. 140 Issue 1, p18
Academic Journal
This article focuses on a study regarding diagnosis of adrenal insufficiency (AI), published in the 2003 issue of the journal "Annals of Internal Medicine." Systematic reviews may provide highly precise estimates of the properties of diagnostic tests. These reviews can offer evidence of different test performances in different settings or in patients with different spectrums of disease. The strongest inference from this study is that the cosyntropin test performs well in patients with AI, the group in which it is needed the least. Given that primary AI is rare, patients with a positive cosyntropin test will require additional testing to avoid unnecessary lifelong corticosteroid replacement. Clinicians considering the diagnosis of primary AI in a patient with nonspecific symptoms may consider measuring plasma cortisol and adrenocorticotropic hormone.


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