The Curbsiders Internal Medicine Podcast #411 Adrenal Insufficiency with Dr. Atil Kargi
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Oct 9, 2023 Dr. Atil Kargi, an expert in adrenal insufficiency, discusses diagnosing, managing, and treating adrenal insufficiency with a focus on interpretation of stimulation tests, distinguishing primary from secondary adrenal insufficiency, and educating patients about preventing adrenal crises. They also explore diagnostic testing options, medication adjustments, and the importance of involving an endocrinologist in the process.
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Initial Adrenal Insufficiency Testing
- Check an early morning cortisol level (around 8-9 a.m.) as the first test for adrenal insufficiency.
- Levels below 3-5 mcg/dL suggest insufficiency, while levels above 15 mcg/dL effectively rule it out.
ACTH and Cortisol Interpretation
- A normal cortisol level doesn't rule out primary adrenal insufficiency if ACTH is very high.
- An elevated ACTH with a normal cortisol is similar to subclinical hypothyroidism with a high TSH and normal T4.
Simplified Cosyntropin Test
- For the cosyntropin stim test, give 250 mcg cosyntropin IM and check cortisol 30-60 minutes later.
- A cortisol level above 19 mcg/dL effectively rules out adrenal insufficiency.