© 2007 American Thoracic Society
The Diagnosis of Relative Adrenal Insufficiency: The Long and Winding Road...From the Author:Drs. De Waele and Hoste, using the data from our article (1), found different values for the likelihood ratio of adrenal insufficiency when stimulated cortisol levels are above 44 µg/dl or when delta cortisol is above 16.8 µg/dl. However, they analyzed these data in a different manner by extracting single cutoffs, whereas we used all cutoffs, which is the appropriate way to do this analysis (2). In our study, the 95% confidence interval of the likelihood ratios for stimulated total cortisol levels > 44 µg/dl and for delta cortisol > 16.8 µg/dl supported our conclusion that adrenal insufficiency is unlikely in patients meeting this criteria. Furthermore, when one looks at the graphical representation of patients according to the results of the cosyntropin test, it is obvious that, when baseline or stimulated total cortisol levels are above 44 µg/dl or delta total cortisol is above 16.8 µg/dl, the chances of having normal adrenal function are maximal. Finally, it is this author's opinion that it is clinically meaningful that high circulating levels or a large increase in cortisol levels after cosyntropin stimulation likely rule out adrenal insufficiency.
Hôpital Raymond Poincaré (APHP) Université de Versailles Saint Quentin, Garches, France FOOTNOTES Conflict of Interest Statement: D.A. does not have a financial relationship with a commercial entity that has an interest in the subject of this manuscript. REFERENCES
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