Table 5 Screening recommendations for AS
When to Screen? | ► Patient has persistent symptoms of AS: Weakness/fatigue, malaise, nausea, vomiting, diarrhea, abdominal pain, headache (usually in the morning), poor weight gain, myalgia, arthralgia, psychiatric symptom, poor growth, hypotension*, hypoglycemia* ► Patient has been receiving high-dose ICS therapy for 3-6 months: ≥500 μg/day of fluticasone; ≥1000 μg/day of budesonide/beclomethasone; or >1000 μg/day of ciclesonide ► Patient has received oral corticosteroids for: >2 consecutive weeks or >3 cumulative weeks in the last 6 months ► Patient using concomitant ICS therapy and potent CYP3A4 inhibitors, particularly antiretroviral and antifungal agents |
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â–º Complete first morning (08:00 am) cortisol test | |
   - Must be completed by 8:00 am or earlier | |
   - No oral glucocorticoids the evening and morning prior to the test | |
   - Fasting not required | |
How to Screen? | â–º If result is normal, screen again in 6 months |
â–º If result is normal but patient has symptoms of AS, perform low-dose ACTH stimulation test to confirm diagnosis: | |
   - 1 μg of cosyntropin; cortisol levels taken at 0, 15-20 and 30 minutes | |
   - Peak cortisol < 500 nmol/L = AS (peak >500 nmol/L is normal) | |
When to be Concerned? | â–º 8:00 am cortisol value < 85 nmol/L = diagnosis of AS â–º 8:00 am cortisol value < laboratory normal = possible AS; consider endocrinology referral for confirmation of diagnosis |