Adrenal Insufficiency: Likelihood Ratios

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

Population / Calculator	Prevalence	Comments / Study / Link
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The likelihood ratios of findings for Adrenal Insufficiency are listed below. See the left navigation bar to change the display.

Good Positive and Negative Likelihood Ratios

Finding	+LR	-LR	Comments, Study
High-Dose ACTH Stimulation Test Duplicate	19.4	0	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
Low-Dose ACTH Stimulation Test	12.2	0.4	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 Duplicate	11.4	0.5	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
Morning Serum Cortisol Duplicate	2.7	0.5	< 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

Good Positive Likelihood Ratio

Morning Serum Cortisol
Duplicate

inf

0.6

< 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