What are the limitations of the adrenal insufficiency probability score?

While the adrenal insufficiency probability score is highly validated, it should not replace clinical judgment. OpiCalc provides the latest evidence-based limitations for the adrenal insufficiency probability score to ensure safe bedside use and optimal diagnostic accuracy.

How does the adrenal insufficiency probability score compare to other Endocrinology scores?

The adrenal insufficiency probability score is a gold-standard diagnostic tool. OpiCalc provides side-by-side clinical guidance to help clinicians choose the most specific evidence-based tool for their patient's presentation.

Is the adrenal insufficiency probability score free to use?

Yes. OpiCalc provides the adrenal insufficiency probability score completely ad-free and optimized for mobile bedside use, ensuring you can calculate medical risk swiftly and without distraction.

Evidence-Based Adrenal insufficiency probability score Scoring

CLINICAL REFERENCE

CLINICAL INSIGHT

When to Use

When to evaluate

Unexplained weight loss, fatigue, malaise, or abdominal pain.
Unexplained hyponatremia, particularly if accompanied by hyperkalemia.
Unexplained hypotension, especially orthostatic refractory to fluids.
Hyperpigmentation of creases and mucous membranes (Primary AI).
Patients with other autoimmune endocrine diseases (Type 1 DM, vitiligo, hypothyroidism).

CLINICAL INSIGHT

How it Works

Morning Cortisol Interpretation (drawn 8-9 AM)

Cortisol Level (µg/dL)	Probability	Next Action
< 3 µg/dL (<80 nmol/L)	AI highly probable / confirmed	Treat, then investigate cause
3 – 14.9 µg/dL	Indeterminate	Perform Short Synacthen Test (CST)
≥ 15 µg/dL (415 nmol/L)	AI unlikely (in general population)	Look for other causes

CLINICAL INSIGHT

Practical Pearls

CBG Binding

Total cortisol is heavily bound to Corticosteroid-Binding Globulin (CBG). Estrogen therapy and pregnancy increase CBG (falsely high total cortisol). Malnutrition and liver failure decrease CBG (falsely low total cortisol).

The Acute Patient

In critically ill patients, a morning cortisol of >15 may be inappropriately low because severe stress usually drives cortisol >25-34 µg/dL. Treat acute suspicion with DEXAMETHASONE before testing, as it avoids interference with the cortisol assay.

CLINICAL INSIGHT

Next Steps

Differentiating Primary vs Secondary AI

Check early morning paired Cortisol and ACTH.
High ACTH (>2x upper normal) = Primary AI (Addison's). Check 21-hydroxylase antibodies, renin/aldosterone, adrenal imaging.
Normal/Low ACTH = Secondary or Tertiary AI. Requires pituitary/hypothalamic evaluation.

CLINICAL INSIGHT

Evidence Base

Guidelines

Diagnosis and Treatment of Primary Adrenal Insufficiency: An Endocrine Society Clinical Practice Guideline

Bornstein SR, et al.J Clin Endocrinol Metab2016

When to Use

When to evaluate

How it Works

Morning Cortisol Interpretation (drawn 8-9 AM)

Practical Pearls

CBG Binding

The Acute Patient

Next Steps

Differentiating Primary vs Secondary AI

Evidence Base

Guidelines

Adrenal Insufficiency Probability Score

When to Use

When to evaluate

How it Works

Morning Cortisol Interpretation (drawn 8-9 AM)

Practical Pearls

CBG Binding

The Acute Patient

Next Steps

Differentiating Primary vs Secondary AI

Evidence Base

Guidelines

Adrenal Insufficiency Probability Score

Clinical Evidence and Methodology

When to Use

When to evaluate

How it Works

Morning Cortisol Interpretation (drawn 8-9 AM)

Practical Pearls

CBG Binding

The Acute Patient

Next Steps

Differentiating Primary vs Secondary AI

Evidence Base

Guidelines

Adrenal Insufficiency Probability Score

Clinical Evidence and Methodology

When to Use

When to evaluate

How it Works

Morning Cortisol Interpretation (drawn 8-9 AM)

Practical Pearls

CBG Binding

The Acute Patient

Next Steps

Differentiating Primary vs Secondary AI

Evidence Base

Guidelines

Adrenal Insufficiency Probability Score