Adrenal Insufficiency: Sensitivity and Specificity

Introduction: If primary (i.e. due to lack of production by the adrenals), it is known as Addison's Disease.

Gold standard tests include the metyrapone test (for secondary AI - looking for an increase in ACTH after metyrapone blocks cortisol synthesis) and the cortisol response to insulin-induced hypoglycemia.

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Prevalence

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The sensitivity and specificity of findings for Adrenal Insufficiency are listed below. See the left navigation bar to change the display.

Pre-Test Probability (Prevalence): %.	Post-Test Probability (Predictive Value): %.	Switch to display mode.
Note that calculating probabilities from more than one** finding is inherently inaccurate because findings are not independent. (For example, using two positive findings that share a common pathogenesis is likely to overestimate the true probability.)

Sensitive and Specific Findings
Finding	Result	Sensitivity	Specificity
[ + ] High-Dose ACTH Stimulation Test	+ 0 -	97%	95%
for primary adrenal insufficiency (sens much lower for secondary) using 250 mcg of cosyntropin (high-dose stim) Study: Ann Intern Med 2003 Aug 5;139(3):194-204. PMID 12899587

Specific Findings
Finding	Result	Sensitivity	Specificity
[ + ] Morning Serum Cortisol	+ 0 -	36%	100%
< 5 mcg/dl gold standard - subnormal serum cortisol response to insulin-induced hypoglycemia Study: J Clin Endocrinol Metab 1998 Jul;83(7):2350-4. PMID 9661607
[ + ] Low-Dose ACTH Stimulation Test	+ 0 -	61%	95%
for seconary adrenal insufficiency the sensitivity is low because partially atrophic adrenals can still respond; the sensitivity improves as the duration of the AI is longer low dose stim = 1mcg cosyntropin Study: Ann Intern Med 2003 Aug 5;139(3):194-204. PMID 12899587
[ + ] High-Dose ACTH Stimulation Test	+ 0 -	57%	95%
for secondary adrenal insufficiency the sensitivity is low because partially atrophic adrenals can still respond; the sensitivity improves as the duration of the AI is longer high-dose stim = 250 mcg of cosyntropin Study: Ann Intern Med 2003 Aug 5;139(3):194-204. PMID 12899587

Poorly Diagnostic Findings
Finding	Result	Sensitivity	Specificity
[ + ] Morning Serum Cortisol	+ 0 -	62%	77%
< 10 mcg/dl gold standard - subnormal cortisol response to insulin-induced hypoglycemia Study: J Clin Endocrinol Metab 1998 Jul;83(7):2350-4. PMID 9661607