Procedure | Considerations for testing |
All tests |
|
First morning cortisol ‡ |
|
Low dose ACTH stimulation§ |
|
Standard dose ACTH stimulation |
|
*In some cases, it may be unsafe to hold medications for the duration required. Consideration of a wean to physiological hydrocortisone dosing may be made in some circumstances to facilitate testing and address safety concerns.
†In children where it is unsafe to hold evening inhaled corticosteroid dose, abnormal cortisol levels must be interpreted with caution.
‡In infants and children with disrupted sleep–wake cycles, an abnormal first morning cortisol is not diagnostic of AS. Provocative testing is indicated.
§For infants: corticotropin dose=15 µg/kg up to a maximum dose of 250 µg.
¶Careful dilution and timely administration of corticotropin is required.74
**Protocols for low-dose ACTH stimulation tests including timing of cortisol samples may vary between institutions.
††Provocative testing is required to definitively rule in or out AS.
ACTH, adrenocorticotropic hormone; AS, adrenal suppression.