The Caveats of Corticotropin Stimulation Test in Diagnosing Secondary Adrenal Insufficiency: Case Reports and Literature Review
Bibliographic record
Abstract
Corticotropin stimulation test (CST) is commonly used to diagnose secondary adrenal insufficiency. We present two patients who underwent transsphenoidal pituitary surgery for pituitary macroadenoma. Both patients had additional pituitary hormone deficiencies before and after the surgery. The patients were maintained on glucocorticoid (GC) replacement for at least 3 months after the surgery. In the remote follow-up period, they underwent conventional CST with resultant cortisol levels above 18 ug/dL. This led to discontinuation of GC treatment. Few months later, both patients developed clinically evident adrenal insufficiency. Providers should be cautious interpreting the results of CST in patients with pituitary disorders. The 250-ug CST with standard cortisol cutoff has low sensitivity and can give falsely reassuring results. Thus, it is prudent to use a higher cortisol threshold to define intact hypothalamic-pituitary-adrenal axis. J Endocrinol Metab. 2016;6(5):154-157 doi: http://dx.doi.org/10.14740/jem366w
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How this classification was reachedexpand
Full frame machine prediction
Teacher imitationNot calibrated prevalence, not ground truth. Human validation pending. The Gemma side is a direct model label for every work in the frame, read from the title-only record. The Codex side is a classifier learned from the 10,348 direct Codex labels and calibrated to design-weighted sample rates; fields without enough sample support carry no Codex call. Candidate is the union of the two sides; consensus is their intersection. These outputs are machine_predicted_unvalidated and are not human labels.
Distilled classifier scores by category (both heads)
| Category | Codex | Gemma |
|---|---|---|
| Metaresearch | 0.001 | 0.007 |
| Meta-epidemiology (narrow) | 0.002 | 0.001 |
| Meta-epidemiology (broad) | 0.001 | 0.001 |
| Bibliometrics | 0.008 | 0.006 |
| Science and technology studies | 0.001 | 0.002 |
| Scholarly communication | 0.002 | 0.004 |
| Open science | 0.003 | 0.002 |
| Research integrity | 0.004 | 0.002 |
| Insufficient payload (model declined to judge) | 0.002 | 0.001 |
Machine scores (provisional)
The two teacher heads of the student model, read on this work. A score orders the frame for review; it never asserts a category, and the validation status ships verbatim with every row.
Baseline scores from an immature model (maturity gate not passed, 7 training rounds). Scores rank; they never assert a category.
score_only:v0-immature-baseline · verbatim from the scoring run: score_only means the number may rank works, and no category label ships from itClassification
machine, unvalidatedMachine predicted; a candidate call from one source (direct Gemma or distilled Codex), not a consensus.
How this classification was reached, model by model and score by score, is at the end of the page under "How this classification was reached".