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Performs corticotropin stimulation test to diagnose adrenal insufficiency when morning cortisol is indeterminate (3-15 µg/dL). Triggers include morning cortisol 3-15 µg/dL requiring further AI testing.
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SOC 職業分類に基づく
Drug-interaction and co-medication adjustment reference for a child on Genryzon (somatrogon, weekly long-acting growth hormone). Covers glucocorticoids, insulin and oral hypoglycaemics, thyroxine, oral estrogen, and CYP3A4-metabolised drugs (sex steroids, corticosteroids, anticonvulsants, ciclosporin). Use when a clinician asks about drug interactions with Genryzon or somatrogon, prescribing another drug in a child on GH, girl on Genryzon starting OCP, diabetic child starting GH, adjusting hydrocortisone on GH, or CYP3A4 concerns with somatrogon. Grounded in the Pfizer India Product Monograph (Genryzon LPD, 2022 — PfLEET 2022-0081166).
Titrate Genryzon (somatrogon, weekly long-acting growth hormone) dose in a paediatric GHD patient using serum IGF-1 SDS. Encodes the mandatory 4-days-post-dose sampling rule, the target SDS window, the 15% dose-reduction trigger, and the oral estrogen adjustment. Use when a clinician asks how to titrate somatrogon, when to sample IGF-1 on Genryzon, target IGF-1 SDS on weekly GH, what to do if IGF-1 is too high on somatrogon, IGF-1 rising on Genryzon, how to adjust GH dose in a girl started on oral OCP, or presents a paediatric GHD case on somatrogon with an IGF-1 value to interpret. Grounded in the Pfizer India Product Monograph (Genryzon LPD, 2022 — PfLEET 2022-0081166).
Bedside prescribing reference for Genryzon (somatrogon, Pfizer India) — the once-weekly long-acting growth hormone for paediatric growth hormone deficiency. Use when a clinician asks how to start Genryzon, how to dose somatrogon in a child, how to switch a child from daily growth hormone to weekly somatrogon, how to inject the Genryzon pen, missed-dose rule for somatrogon, when to stop somatrogon, or needs a monograph-level prescribing decision for a paediatric GHD patient. Applies to children and adolescents ≥3 years of age. Grounded in the Pfizer India Product Monograph (Genryzon LPD, 2022 — PfLEET 2022-0081166).
Pretreatment screening checklist before starting Genryzon (somatrogon, weekly long-acting growth hormone) in a child with confirmed paediatric growth hormone deficiency. Ensures thyroid, adrenal, glucose, ocular, tumour, and Prader-Willi status are checked before the first dose to prevent adrenal crisis, wasted therapy, unmasked hypothyroidism, unrecognised hyperglycaemia, missed intracranial hypertension, or sudden death in PWS. Use when a clinician asks what to check before starting somatrogon, workup before Genryzon, baseline tests for weekly GH, screening for adrenal insufficiency before GH, or is about to prescribe Genryzon in a paediatric GHD case. Grounded in the Pfizer India Product Monograph (Genryzon LPD, 2022 — PfLEET 2022-0081166).
Red-flag safety scan for a child on Genryzon (somatrogon, weekly long-acting growth hormone) — recognise and act on the treatment-emergent adverse events that require holding, investigating, or stopping the drug. Covers benign intracranial hypertension, slipped capital femoral epiphysis, pancreatitis, injection-site myositis (m-cresol), scoliosis progression, second neoplasm surveillance in cancer survivors, hyperglycaemia unmasking, and adrenal insufficiency unmasking. Use when a clinician asks what side effects to watch for on Genryzon, red flags on weekly GH, headache in a child on somatrogon, limp in a child on GH, abdominal pain on Genryzon, or is following up a paediatric GHD patient on somatrogon. Grounded in the Pfizer India Product Monograph (Genryzon LPD, 2022 — PfLEET 2022-0081166).
Decide when to stop Genryzon (somatrogon, weekly long-acting growth hormone) in a paediatric GHD patient — the three physiological gates (epiphyseal closure, height velocity <2 cm/year, bone age >14 in girls or >16 in boys) plus the safety-driven stops (active tumour, adult GHD re-evaluation, adverse events). Use when a clinician asks when to stop somatrogon, when to discontinue Genryzon, is the child done with GH, has this child reached final height on GH, transitioning GH from paediatric to adult care, or is reviewing a teenager who has been on Genryzon for years. Grounded in the Pfizer India Product Monograph (Genryzon LPD, 2022 — PfLEET 2022-0081166).
| name | ata-acth-stim-test-interpretation |
| description | Performs corticotropin stimulation test to diagnose adrenal insufficiency when morning cortisol is indeterminate (3-15 µg/dL). Triggers include morning cortisol 3-15 µg/dL requiring further AI testing. |
Obtain morning serum cortisol level drawn between 8–9 AM after an overnight fast; confirm patient has been off glucocorticoids for at least 18–24 hours after last hydrocortisone dose or longer for synthetic glucocorticoids; assess for estrogen therapy that may increase corticosteroid-binding globulin and total cortisol.
If morning cortisol ≤3 µg/dL, adrenal insufficiency is likely (rule in); if morning cortisol ≥15 µg/dL, adrenal insufficiency is unlikely (rule out); if morning cortisol is between 3–15 µg/dL, proceed to corticotropin stimulation test.
Administer 250 µg cosyntropin (ACTH1–24) intravenously or intramuscularly; measure serum cortisol at 30 and/or 60 minutes; peak cortisol ≤18.1 µg/dL (500 nmol/L) indicates adrenal insufficiency; peak cortisol >18.1 µg/dL makes adrenal insufficiency unlikely.
If adrenal insufficiency is diagnosed, initiate glucocorticoid replacement (e.g., hydrocortisone 15–20 mg daily in divided doses) and provide stress-dose education; if adrenal insufficiency is ruled out, investigate alternative causes of symptoms.
Estrogen therapy can raise total cortisol via increased corticosteroid-binding globulin, potentially masking adrenal insufficiency; ensure adequate glucocorticoid washout to avoid false-normal results; the test has moderate accuracy with limited sensitivity, so clinical judgment remains essential; peak cortisol cutoffs may vary by assay, verify local laboratory reference ranges.
A 55‑year‑old woman on oral estrogen therapy has a morning cortisol of 11 µg/dL; after confirming 24‑hour hydrocortisone washout, she undergoes standard‑dose ACTH stimulation; cortisol at 60 minutes is 16 µg/dL, leading to a diagnosis of adrenal insufficiency and initiation of hydrocortisone 10 mg morning and 5 mg afternoon.
Source: Hormonal Replacement in Hypopituitarism in Adults: An Endocrine Society Clinical Practice Guideline, Endocrine Society, 2016, DOI:10.1210/jc.2016-2118
TODO: consider adding scripts/calc.py for the ata-acth-stim-test-interpretation calculator
