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Volume 361:824-825 August 20, 2009 Number 8
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Predisposing Factors for Adrenal Insufficiency

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by Bornstein, S. R.
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To the Editor: The review of predisposing factors for adrenal insufficiency by Bornstein (May 28 issue)1 includes a welcome discussion of the limitations of current tests that measure plasma cortisol levels in critically ill patients. However, in the review, stimulation with 1 µg of corticotropin is recommended to identify patients with relative adrenal insufficiency, and I believe the current evidence does not support this.

At least two studies2,3 have questioned the reproducibility of corticotropin stimulation testing in critically ill patients. A substantial number of patients appear to have different responses to 250 µg of corticotropin when they are tested on . . . [Full Text of this Article]



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