Cortisol Stim Test

I'm a bit fuzzy on this, others can feel free to clarify.. but basically

In primary adrenal insufficiency and Addison's disease the base cortisol will be low 10- teens and after the cosyntropin (med) it will rise about 25%.

In secondary adrenal insufficency the base cortisol will be low about 10mcg/dl, and after the cosyntropin is delivered it will double, triple.

In a healthy person, the cortisol level should go from about 20mcg/dl to at least 50mcg/dl.

Nausea, anxiety, sweating and dizziness are normal side effects. Some pts actually report no side effects or report feeling better. Fainting, severe dizziness, irregular hearbeat, dyspnea and rash are rare side effects and I've never had this happen to me, but it has happened to a pt on my floor once.

Pt's do need to be NPO for the procedure, so we usually do the test at 0500.

The ACTH is done to screen septic patients for adrenal insufficiency. However, it is now recommended to give low-dose steroids despite what the results of this test may be. The test may be more helpful later on when the steroids are being tapered.

http://www.pubmedcentral.nih.gov/articlerender.fcgi?artid=137442

http://jlgh.org/content/pdf/vol1_issue2/kontra_-_evidence-based_management.pdf

http://www.survivingsepsis.org/bundles/individual_changes/administer_lowdosesteroids

My understanding was that the test needs to be administered in the early am to take advantage of the natural rise/fall of cortisone levels?

Thank-you, all for the information, This does help me understand