What is the sensitivity and specificity of the cosyntropin (ACTH) stimulation test for adrenal insufficiency?
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Standard-dose, 250-mcg cosyntropin (ACTH) stimulation testing is 97.5% sensitive and 95% specific for the diagnosis of primary adrenal insufficiency. For the diagnosis of secondary adrenal insufficiency, the testing is less sensitive. With specificity set to 95%, the 250-mcg test has a sensitivity of 57% and the 1-mcg test has a sensitivity of 61%. No demonstrable difference has been found between the standard-dose and low-dose tests in diagnosing secondary adrenal insufficiency. (SOR A, based on systematic review of consistent level 1 studies.)
Evidence Based Practice 12(8): 09.