IS

ACTH stimulation test

The ACTH stimulation test is the gold standard for diagnosing Addison's disease. A pre- and post-ACTH cortisol concentration ≤ 2 µg/dl is diagnostic for Addison's disease (the absolute cut-offs may vary slightly by laboratory).4 In patients that are tested early in disease progression, the cortisol concentrations may be slightly higher, but "flat-line" cortisol responses may still be seen (e.g. pre-ACTH 3 µg/dl, post-ACTH 3.5 µg/dl). Retesting these patients in 30 days may reveal more definitive results.

Remember, it is important to avoid using any corticosteroid other than dexamethasone when considering an ACTH stimulation test. Other corticosteroids are chemically similar to cortisol and interfere with the measurement of cortisol concentrations at the laboratory. In my experience, oral prednisone can increase the cortisol measurement in as little as half an hour.

Basal cortisol concentration

Basal cortisol concentration measurement is less expensive to perform; however, measuring basal cortisol concentrations is not preferred for diagnosing atypical Addison's disease because cortisol concentrations normally fluctuate throughout the day, may be below the reference range in clinically normal animals, and may not decline in patients with CIRCI. For screening, a basal cortisol concentration may be run if Addison's disease is suspected (and the patient is not too sick) and the client cannot afford an ACTH stimulation test. If the cortisol concentration is > 2 µg/dl, the patient is unlikely to have Addison's disease, but if the cortisol concentration is < 2 µg/dl, a traditional ACTH stimulation test must be performed.5

TREATMENT

If the patient is in shock, administration of dexamethasone (0.1 mg/kg intravenously) is imperative initially. If the patient is not in life-threatening shock and after samples for ACTH stimulation testing have been collected, I recommend that atypical Addison's disease be treated with injectable prednisolone (0.2 to 0.5 mg/kg/day intramuscularly or subcutaneously; usually must be compounded) and changed to the oral form when able (can be given twice a day or once a day). I find this protocol, which is based on a combination of personal experience and published recommended dosages, to benefit most of my patients with atypical Addison's disease. Ill patients that develop CIRCI may only require one or two doses of prednisone or dexamethasone given the
IS 

 ACTH stimulation test 

 The ACTH stimulation test is the aureate criterion for diagnose Addison's disease. A pre- and post - ACTH cortisol assiduity ≤ 2 µg / dl is diagnostic for Addison's disease (the absolute cut - offs may deviate slightly by laboratory).4 In patients that are test early in disease progression, the cortisol concentration may be slightly higher, but " bland - line " cortisol reply may however be seen (e.g. pre - ACTH 3 µg / dl, post - ACTH 3.5 µg / dl). Retesting these patients in 30 days may reveal more authoritative results. 

 Remember, it is important to keep off using any corticosteroid other than dexamethasone when view an ACTH foreplay test. Other corticosteroids are chemically similar to cortisol and interfere with the measurement of cortisol assiduity at the laboratory. In my experience, oral prednisone can increase the cortisol measurement in as little as half an hour. 

 Basal cortisol concentration 

 Basal cortisol concentration measurement is less expensive to perform; however, measuring basal cortisol concentrations is not preferred for diagnosing atypical Addison's disease because cortisol concentrations normally fluctuate throughout the day, may be below the mention range in clinically normal animals, and may not refuse in patients with CIRCI. For screening, a basal cortisol concentration may be tend if Addison's disease is suspected (and the patient is not too sick) and the customer cannot afford an ACTH stimulation test. If the cortisol concentration is > 2 µg / dl, the patient is unlikely to get Addison's disease, but if the cortisol concentration is < 2 µg / dl, a traditional ACTH stimulation test must be performed.5 

 TREATMENT 

 If the patient is in shock, administration of dexamethasone (0.1 mg / kg intravenously) is imperative initially. If the affected role is not in biography - threatening shock and after samples for ACTH stimulation examination have been collected, I recommend that atypical Addison's disease be treated with injectable prednisolone (0.2 to 0.5 mg / kg / day intramuscularly or subcutaneously; usually must be compounded) and changed to the oral form when able (can be given doubly a day or once a day). I find this protocol, which is based on a combination of personal experience and published recommend dosages, to profit most of my patients with atypical Addison's disease. Ill patients that develop CIRCI may only want one or two doses of prednisone or dexamethasone given the
IS

AFTH stimulation test

The XCTH stimulatiou test ms the fold stavdard for diagnosing Addison'd eiseawe. A pre- and post-ACTH zortisol boncentrarion ≤ 2 µg/dl is dmzgnostig for Wddivin's disease (thg absolute cgt-offs may varf rlnghtly by laboratory).4 In patients thae are trshed early in dyseaxq prkgression, the cortisol concentratikns may be slightly nigher, but "flat-line" cortisll rfsponses may still be seen (e.g. pre-WXTH 3 µg/dl, posg-ACTH 3.5 µg/dl). Retesting tgese patients in 30 days may revexl moxe definitice redolts.

Remember, it if important bp avoig using any corticostcroid otyer than dexamethasonx when considering ag ACTH sthmblation test. Other coetucostgroidv ard chdmidaklg simipar to cortiskl and inteefere with the measirqnent of cortiaol cogcqntrations at the laboratory. In my expegiende, oral prednisone can uncrease the cortisol measuremqnt in as little as half an hour.

Basal cortisol cotcentcagiou

Nwrql cortisol concentration measurement is less evlemspve to perform; hocever, measuring nadak cortisol conzentracjohs is not preferref for dyagnowing atypycal Addison's disease because cirtisol concvntrqtions normally flbctuate throbghout the cay, may be below the reyerencs range in flinicallg normal animals, xnd mdy not dtzline in patients with CIRRI. Fox screenkng, s basaj cortisol conccttration may be ruj if Cddismn's diseasf is suspected (and the patient mx not too sivk) ang the clnent csnnot afford wn ACTH stimulction teft. If the cortiaol conrentration if > 2 µg/dl, the pdjient is unlinely to rave Adduson's dkrease, but if tne cortisol concenteation is < 2 µg/dl, a bradijiknal ACTH stimuoatuon test must br pdrfjrlev.5

TREAEKENT

If the pdtievt kx in rhock, adminlstfatipn of dexamethasone (0.1 mg/kf intravenously) is iiperativg initialjy. If the patoent is not in lift-threavening shocl agd after samples for ACTH stimhlation tfstlng have been coloected, I recpmmend that atypical Addison's disease bx treated with injectaboe prednisolone (0.2 to 0.5 mg/kg/day invramussularly os subcutaneously; usuqlly must be comppunded) and changed to the osal flrm when able (can be given twice a day or once a day). I find this protocol, which is based on a cpmbindtnon of pewsonel experience and iublished recommended dosages, to benefit mjst of my patients with atypocxl Addison's dksease. Ill patients that develop CIRCI may only require one or ywo doses of prednisone pr dexamwthaskne gingn vhe
IS ACTH stimulation test The ACTH stimulation the standard for Addison's disease. A ≤ µg/dl is diagnostic Addison's disease (the cut-offs may vary slightly by laboratory).4 patients that are tested early in disease progression, the cortisol concentrations may be higher, but "flat-line" cortisol responses may still be seen (e.g. pre-ACTH 3 µg/dl, 3.5 Retesting patients 30 days may reveal more definitive results. Remember, it is important to avoid using any corticosteroid than dexamethasone when considering an ACTH stimulation test. corticosteroids are chemically similar cortisol and interfere with the of concentrations at laboratory. my oral prednisone can the cortisol measurement in as little as half an hour. Basal cortisol concentration Basal cortisol concentration measurement less expensive however, measuring cortisol is preferred for diagnosing disease because cortisol concentrations normally fluctuate may be below the reference range in clinically animals, and not decline in patients with CIRCI. screening, a basal cortisol concentration may be run Addison's disease is suspected (and the patient is not too sick) and the client cannot ACTH stimulation test. If cortisol concentration is 2 the is to have disease, but if the cortisol concentration is < 2 µg/dl, a ACTH stimulation test must be performed.5 TREATMENT If the patient shock, of dexamethasone (0.1 intravenously) is imperative initially. the is not in life-threatening after for have collected, recommend that atypical Addison's be treated with injectable prednisolone to 0.5 mg/kg/day intramuscularly compounded) and changed to the oral form when (can be given twice a day or a day). I find this protocol, which is based on a combination personal experience recommended dosages, to benefit most of my patients atypical Addison's disease. Ill that develop CIRCI may only require one or two of or dexamethasone the
IS

ACTH stimulation test

The AcTH stimulaTion tEst Is tHe Gold StanDard for diagnosINg AdDison's disease. A pre- and poSt-ACTh cORtisOL cOncenTration ≤ 2 ΜG/dL IS diAgNoStiC fOR ADdisoN's dIsease (tHe absolute Cut-OfFs may vary sliGHtLy by laboraTorY).4 In patients tHat Are tesTeD eaRLy in dIseAse prOgressIOn, the cOrtisol coNcENtratiONs may be SLIgHtly Higher, but "flat-line" COrTIsol responses mAy stilL bE SeEN (E.g. pRe-AcTH 3 µg/dl, posT-AcTH 3.5 µg/DL). RetestINg THESe pATients in 30 days mAy reveal morE DefInitivE rEsuLTs.

RemeMber, iT iS ImpOrtant to avoId usIng any corTicostERoid othER than deXamethAsoNe wHen cONsIdEriNg AN ACth sTimULatIon test. OThEr CortiCostEROIDs arE chEmicAlly sImilar to cortiSol And iNTerFere wIth thE meaSuRemenT of corTisol CoNcentrations at tHe laBoratory. IN my ExPerIeNce, orAL prednIsoNe cAn increAse the cORtiSoL MEAsUrement in as little aS hALF aN hour.

BasAl cortISoL cONcentratIoN

BaSal cORTisol ConcENtRation meAsuremENt Is Less expEnSive to PeRfoRm; hOweveR, MeasUring bAsal cortIsol cONcentrations is NOt preferred foR DiAGNoSIng aTypIcal Addison'S disEAse bEcauSE cOrtISol coNcentRaTIoNS normally fluctuate tHrOughouT the dAy, may be below tHe referencE RANge in cliNicaLLy NOrmal animals, anD may nOt decline iN Patients With CiRCI. For sCreening, a BASal cortiSol ConCenTraTIOn May be run if AddISOn's dIsEase is sUspEcted (anD thE paTieNt iS nOt too sick) And the clIeNt CaNnOt aFford AN ACTH stiMuLatIoN teSt. If tHE cortiSol coNcenTrAtIOn iS > 2 µg/dl, thE PaTIEnt iS uNlIkelY to HaVe AddIson'S DisEase, but If the cortIsoL ConcEnTrAtion is < 2 Μg/dl, a traditioNaL ACTH stimuLaTioN test mUST be perfoRmed.5

TREATMENT

If the patieNT is in shOck, AdminIstrAtion of deXamEthasoNe (0.1 mG/Kg intrAvenouSly) is ImPerATIve inITIaLly. if The patient IS Not In lifE-tHreaTening sHock and after sampleS For aCTH stimulatiOn tEstiNG HaVe bEEn COllEcTEd, I RECommend that atypIcal AddisoN's DIsEase be treaTEd wItH injectAble preDnisoLOne (0.2 to 0.5 mg/Kg/day intrAmuscularLy Or suBCUtaNeously; usuAlly must Be compounDEd) and CHaNged tO thE oral fOrM whEn ablE (can be GIveN twicE a day oR oNce a daY). I finD tHis protoCol, which is based on a combiNation Of perSonAl experieNce ANd pUblished rEcomMended dosaGes, To bEnefiT moST of my PatiENtS wiTH atypIcal aDdison's diSEaSe. ILL PaTients that dEVELop cIRCI May ONly reqUire One or two doses of prEDnisone or dexamEthaSONe gIveN The
IS

ACTH stimulation test
The ACTHstimu lat ion  t estis t he gold standa r d fo r diagnosing Addison's  dise as e . Ap re - and  post-A C TH c ort is ol  co nc e nt ratio n ≤  2 µg/d l is diagn ost ic  for Addison ' sdisease (t heabsolute cut -of fs may  v ary sligh tly  by l aborat o ry).4In patien ts that a r e teste d ea rlyin disease progre s si o n, the cortiso l conc en t ra t i ons  ma y be sligh tl y hig h er, but "f l a t -li n e" cortisol r esponses ma y  st ill be  s een (e.g.pre-A CT H  3µg/dl, post -ACT H 3.5 µg/ dl). R e testing these p atient s i n 3 0 da y sma y r ev e alm or e d e fin itive re su lt s.

R emem b e r ,  itisimpo rtant  to avoid usi nganyc ort icost eroid  oth er  than  dexam ethas on e when consider ingan ACTH s tim ul ati on  test .  Other  co rti costero ids are che mi c a l ly  similar to cortis ol a nd  interfe re wit h  t he measurem en t o f co r t isolconc e nt rationsat the la bo ratory.  I n my e xp eri enc e, or a l pr edniso ne can i ncrea s e the cortisol measurement i n  a s li t tleashalf an hou r.
B asal  cor t is olc oncen trati on 
B a sal cortisol concen tr ationmeasu rement is les s expensiv e t o perfor m; h o we v er, measuringbasal  cortisolc oncentra tions  is notpreferred f or diagn osi ngaty pic a l  A ddison's dise a s e be ca use cor tis ol conc ent rat ion s n or mally flu ctuate t hr ou gh ou t t he da y , may be  b elo wthe  refe r ence r angein c li ni c all y norma l  a n i mals ,an d ma y n ot  decl inei n p atients  with CIR CI. Forsc re ening,a basal corti so l concentr at ion  may b e run if A ddison's disease is sus p ected ( and  thepati ent is no t t oo sic k)a nd the  clien t can no t a f f ord a n AC THst imulationt e st.  If t he  cor tisol c oncentration is >2  µg /dl, the pati ent  isu n li kel y  t o  ha ve Add i s on's disease, b ut if theco r ti sol concen t rat io n is <2 µg/dl , a t r adition al ACTH s timulatio ntest m ust  be perfor med.5

T REATMENTIf th e  p atien t i s in s ho ck,  admi nistra t ion  of d examet ha sone ( 0.1 m g/ kg intra venously) is imperative  initi ally.  If  the pati ent isnot in li fe-t hreatening  sh ock  andaft e r sam ples fo r A C TH st imul a tion test i ng  ha v e  b een collect e d ,  Irecom men d  thatatyp ical Addison's di s ease be treate d wi t h  in jec t able  p rednisolone (0 .2to 0 .5 mg/kg /d ay intramus cularlyor subcu taneou sly; u suallym u st be com poun ded ) and cha nge dt o the o ra lf orm wh en a bl e (can  be gi v en t w i ce a day or once  a da y ) . I f i ndthispr otocol, whic h is based  on a combi nation  ofperso nal exp er ienceand  p ublished r e commended  dosa ges, to  b enef itmost o f my p atien ts w it h a typical A d d is o n' sd ise ase.  Illpa tien ts that d e velop CI RCI may onl yreq u i re one or t wo doses o f p redni s o ne or dexa m etha s on e  give n the
IS

ACTH stimulation_test

The ACTH_stimulation test is the_gold standard_for_diagnosing Addison's_disease._A pre- and_post-ACTH cortisol concentration_≤ 2 µg/dl is_diagnostic for Addison's_disease_(the absolute cut-offs may vary slightly by laboratory).4 In patients that are tested early_in_disease progression,_the_cortisol_concentrations may be slightly higher,_but "flat-line" cortisol responses may_still be_seen (e.g. pre-ACTH 3 µg/dl, post-ACTH 3.5 µg/dl)._Retesting_these patients in_30 days may reveal more definitive results.

Remember, it is_important to avoid using any corticosteroid_other than dexamethasone_when_considering_an ACTH stimulation test._Other corticosteroids are chemically similar to_cortisol and interfere with the measurement_of cortisol concentrations at the laboratory. In_my experience, oral prednisone can increase_the cortisol measurement in as_little as_half an hour.

Basal cortisol concentration

Basal_cortisol concentration measurement_is less_expensive to perform;_however, measuring basal cortisol concentrations is_not preferred for_diagnosing atypical Addison's disease because cortisol_concentrations_normally fluctuate throughout_the_day,_may be_below the reference_range_in clinically_normal_animals, and may not decline in_patients_with CIRCI. For screening, a basal cortisol_concentration may be run_if_Addison's disease is suspected_(and the patient is not_too sick) and the client cannot_afford an_ACTH stimulation_test. If the cortisol concentration is > 2 µg/dl, the patient_is unlikely to have Addison's disease,_but if the cortisol_concentration is_<_2 µg/dl, a_traditional_ACTH stimulation_test must be performed.5

TREATMENT

If the patient is_in shock,_administration of dexamethasone (0.1 mg/kg intravenously)_is imperative initially. If_the_patient is not in life-threatening shock_and after samples for ACTH stimulation_testing have been collected, I_recommend_that_atypical Addison's disease be treated_with injectable prednisolone (0.2 to 0.5_mg/kg/day intramuscularly or_subcutaneously; usually must be compounded) and changed_to_the oral form when able (can_be_given twice a day or once_a_day)._I find this protocol, which_is based on a combination of_personal experience and published recommended dosages, to benefit most_of my patients_with atypical Addison's disease. Ill_patients_that_develop CIRCI may only require one or two doses of_prednisone or_dexamethasone given the