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Old 05-14-2012
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Question Approach to ACTH deficiency

is this an acceptable approach?
assessing the ACTH deficiency:
if cortisol is normal or high then that's it; there is no ACTH deficiency.
if cortsol is low then we do the cosyntropin stimulation;if there is a normal response(rising of cortisol levels) then we have the diagnosis of ACTH deficiency if abnormal respnose(it might be caused by adrenal atrophy) then we move to the CRH stimulation test if there is no rise of ACTH then we get our diagnosis.....what do you think?is it an acceptable approach?

for growth hormone deficiency...IGF-1 is not helpful because normal value doesn't exclude deficiency of growth hormone and a low value also means what do we order?
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Old 05-14-2012
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in kaplan (2009)
start with ACTH stimulation --> got abnormal --> ATCH level & response to aldosteron with ACTH stimulation -->
-primary adrenal (high ACTH, aldo dont increase from baseline following ACTH stim),
Secondary adrenal (low ACTH, aldo increase from baseline following ACTH stim),

in mtb2 i think it mentioned ACTH first if low --> pitu. and if high --> CST

the more high yield point is Adrenal Crisis, where u should treat first before testing
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