Which type of cortisol response would the nurse expect when a patient with secondary adrenal insufficiency undergoes an adrenocorticotropic hormone stimulation test?

Which type of cortisol response would the nurse expect when a patient with secondary adrenal insufficiency undergoes an adrenocorticotropic hormone stimulation test?

• A. Increased
• B. Decreased
• C. No Change
• D. Delayed Increase

Answer: (A)

When the adrenocorticotropic hormone stimulation test is used, you’re checking how well the adrenal cortex can respond to ACTH. In secondary adrenal insufficiency, the problem lies with insufficient ACTH from the pituitary, not with the adrenal glands themselves. The adrenal cortex remains capable of producing cortisol when ACTH is present, so giving exogenous ACTH should prompt a rise in cortisol levels. The cortisol increase confirms the adrenals can respond to ACTH, distinguishing it from primary adrenal insufficiency where the glands are damaged and cortisol would not rise. Note that if ACTH deprivation has been long-standing, the rise may be blunted, but an increased cortisol response is still the expected pattern.

When the adrenocorticotropic hormone stimulation test is used, you’re checking how well the adrenal cortex can respond to ACTH. In secondary adrenal insufficiency, the problem lies with insufficient ACTH from the pituitary, not with the adrenal glands themselves. The adrenal cortex remains capable of producing cortisol when ACTH is present, so giving exogenous ACTH should prompt a rise in cortisol levels. The cortisol increase confirms the adrenals can respond to ACTH, distinguishing it from primary adrenal insufficiency where the glands are damaged and cortisol would not rise. Note that if ACTH deprivation has been long-standing, the rise may be blunted, but an increased cortisol response is still the expected pattern.