Diagnosis of adrenal insufficiency
1. Baseline serum cortisol and ACTH levels
2. Inject 250 mcg cosyntropin (ACTH) intravenously or IM
3. 30 and 60 minute cortisol levels
A rise in cortisol level to greater than 18 ug/dl within 60 minutes demonstrates a normal result. A rise in cortisol to less than 18 ug/dl demonstrates an abnormal response. If the adrenal glands do not adequately stimulate to cosyntropin (ACTH), the patient has suppressed adrenal glands. An elevated baseline ACTH level suggests primary adrenal failure.