If adrenal insufficiency is suspected or ? Addisonian crisis
Then embark on ACTH stimulation test first
ACTH normal level is 6-48pg/ml
Rule out the following before the onset of the test:
Wrong tube, because the correct tube should be plastic
Wrong timing;-between 6-8am is better, but, if critically ill-take the sample at any time.
Any obvious triggers of Addisonian crisis like:
Head trauma
Stress
Amphetamines
Alcohol
Newly damaged pituitary
Effects of : Cushing’s syndrome/ steroid intake
If you are still suspecting adrenal insufficiency and
your ACTH stimulation test is indicating a rise in cortisol level
up to 18-25ug/dl per IV route or
16ug/dl per I.M. route, then go a step further:
Check CRH, to find out if the problem is with Hypothalamus
I have clearly stated the entire steps here and the results carefully recorded. Enjoy listening!
