6919 Overstimulation Overload- Evidence Of Overuse Of The Cosyntropin Stimulation Test In The Hospital Setting

Abstract Disclosure: R. Goldberg: None. F. Thelmo: None. I. Ahmed: None. Introduction The cosyntropin stimulation test (CST), which utilizes a synthetic adrenocorticotropic hormone (ACTH) analog to stimulate the adrenal glands to release cortisol, is a test used to help define the presence or absence of adrenal insufficiency (AI). In primary and secondary AI, cortisol is inappropriately low (<18 mcg/dL) when measured 30 minutes and 60 minutes after administration of cosyntropin. The aim of this study was to assess utilization of CST in Jefferson hospital enterprise and initiation of steroid therapy based on results. Methods A retrospective analysis, using the Slicer Dicer feature of Epic electronic records (Verona, USA) was performed on all adult hospitalized patients from 5/5/2023 and 9/5/2023. Results 149 CST were performed in the above-mentioned period, 61 patients (41%) were male, and 88 patients (59%) were female. Two were excluded from the study as one test was performed incorrectly, and one study had insufficient sample to produce a result. Of the 147 patients, 47 patients (32.0%) were positive for AI. Five of 20 patients (25%) in the ICU were positive for AI. 42 of the 127 patients (33.1%) on the floor were positive for AI. Of the 47 patients diagnosed with AI, 37 were placed on steroid treatment and ten patients were not started on steroids; despite inadequate stimulation, the patient’s clinical picture was not thought to represent AI. Discussion Our analysis points to a relative overutilization of CST in Jefferson hospitals. This may be due to the relative ease of CST in the hospital setting, and clinicians should be overly cautious about ruling out AI despite the presence of more likely explanations for the clinical scenario. Notably, although several patients in the study met criteria for AI, endocrinology chose not to treat them with steroids, which raises the topic of defining AI in the critically ill patient. The validity of CST and normal cortisol cut-offs in the critically ill remain a topic of intense debate. The results of this study should prompt clinicians to think critically before ordering a CST. Despite strict cutoffs for diagnosis of AI, careful consideration of the clinical scenario should be taken into account before initiating patients on steroid therapy. If the diagnosis of AI is confirmed, patients should be followed closely as an outpatient to ensure proper adjustments to medication regimens are made. Presentation: 6/2/2024