When to Screen? |
• Patient has received systemic corticosteroids for: |
> 2 consecutive weeks or >3 cumulative weeks in the last 6 months |
• Patient has persistent symptoms of AS: |
– Weakness/fatigue, malaise, nausea, vomiting, diarrhea, abdominal pain, headache (usually in the morning), poor weight gain and/or growth in children, myalgia, arthralgia, psychiatric symptoms, hypotension*, hypoglycemia* |
How to Screen? |
• Measure early morning cortisol‡ |
– GC dose tapered to physiologic dose prior to test |
– No oral GCs the evening and morning prior to the test† |
– Must be completed by 8:00 am or earlier |
– Fasting not required |
• If morning cortisol 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? |
• Early morning cortisol < 85 nmol/L = diagnosis of AS |
• Early morning cortisol < laboratory normal = possible AS; consider endocrinology referral for confirmation of diagnosis |