Administer Standard Dose Corticotropin Stimulation Test with Age/Weight-Based Dosing
STEP 1 — Gather Information
Record patient age in years and weight in kilograms; verify no glucocorticoid exposure in the past 24 h.
STEP 2 — Rule In / Rule Out
If infant (<1 year), proceed to weight‑based dosing; otherwise go to age‑based stratification.
STEP 3 — Classify or Stratify
If age <2 years (1–2 years), assign fixed dose 125 µg; if age ≥2 years, assign fixed dose 250 µg.
STEP 4 — Decide
Administer the calculated dose as an IV bolus; draw serum cortisol at 30 min (and optionally 60 min) for interpretation.
Clinical Guardrails / Mimics / Pitfalls
Do not test if exogenous glucocorticoids were given within 24 h; avoid in acute adrenal crisis without prior stress dosing; interpret cortisol using assay‑specific cutoffs (peak <500 nmol/L indicates insufficiency); low‑dose (1 µg) test is insufficient for PAI diagnosis.
Concrete Clinical Example
A 15‑month‑old child weighing 10 kg with suspected PAI due to hyperpigmentation and hyponatremia receives 125 µg IV ACTH; cortisol at 30 min is 300 nmol/L (<500 nmol/L), confirming adrenal insufficiency.
Source: Diagnosis and Treatment of Primary Adrenal Insufficiency: An Endocrine Society Clinical Practice Guideline, Endocrine Society, 2016, DOI:10.1210/jc.2015-1710
TODO: consider adding scripts/calc.py for the enda-standard-stim-test-dosing calculator