Oboni et al identified a number of factors which can help to identify a patient being admitted to a medical ward in the hospital who may have adrenal insufficiency. A patient with one or more factors may be a candidate for an ACTH stimulation test. The authors are from University Hospital Lausanne.


Patient selection: patient being admitted to a medical ward of the hospital


Criteria for adrenal insufficiency: serum cortisol < 550 nmol/L after 250 microgram dose of cosyntropin (high dose protocol)


Factors associated adrenal insufficiency:

(1) recent discontinuation of glucocorticoid therapy (most important finding)

(2) nausea

(3) hyperkalemia

(4) eosinophilia


Other findings seen in patients included:

(1) hypotension

(2) fatigue and/or general weakness


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