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Updated: Jun 23, 2026

A Novel Method: Super-selective Adrenal Venous Sampling
Published on: September 15, 2017
Clinical inquiries. What's the most practical way to rule out adrenal insufficiency?
1University of Minnesota/St. Cloud Hospital Family Medicine Residency, St. Cloud, MN USA.
Abstract:
A morning serum cortisol level >13 mcg/dL reliably rules out adrenal insufficiency, and the test is easy and safe to perform. Because of low specificity, patients with a level of < or =13 mcg/dL need further evaluation with the cosyntropin stimulation test (CST). The 250 mcg CST requires intravenous (IV) or intramuscular (IM) administration of cosyntropin and multiple blood draws; a normal response reliably rules out primary adrenal insufficiency and moderately decreases the likelihood of secondary adrenal insufficiency. The 1 mcg CST has better diagnostic discrimination, but requires an extra step to dilute the cosyntropin.
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