Study designs of evaluations included in the review
Inclusion criteria relating to the study design were not stated.
Specific interventions included in the review
Studies of cosyntropin 1 microg were eligible for inclusion. The included studies compared low-dose adrenocorticotropin-releasing hormone (ACTH; 1 and 5 microg) with high-dose ACTH (259 and 250 microg).
Reference standard test against which the new test was compared
Inclusion criteria relating to the reference standard were not stated. The authors identified the insulin tolerance test (ITT) as the 'gold' standard, but stated that ACTH is often used because of contraindications and safety concerns of ITT. The reference standards used included ITTs and 250 microg ACTH.
Participants included in the review
Studies of critically ill patients were eligible for inclusion. The included studies were undertaken in non-critically ill patients (e.g. healthy volunteers, patients with suspected or proven pituitary disease or hypothalamic-pituitary disorders, and patients on long-term glucocorticoids) and critically ill patients (e.g. intensive care unit patients with the human immunodeficiency virus, septic shock, clinically suspected AI, and patients requiring vasopressor support for at least 24 hours).
Outcomes assessed in the review
Studies reporting measures of AI were eligible for inclusion. The included studies reported changes in serum cortisol levels.
How were decisions on the relevance of primary studies made?
The authors did not state how the studies were selected for the review, or how many reviewers performed the selection.