How can patients at risk of adrenal insufficiency be tested preoperatively?
The cosyntropin stimulation test is a simple and reliable method to evaluate the ability of the adrenal gland to respond to stress. After the baseline cortisol level has been obtained, 250 μg of cosyntropin (an adrenocorticotropic hormone [ACTH] analog) is injected IV or intramuscularly, and the cortisol level is measured after 30 and 60 minutes. Patients with a normal HPA axis should be able to double their baseline cortisol level and demonstrate a stimulated value of >20 μg/dL at either 30 or 60 minutes.
