A client receives cosyntropin (Cortrosyn). The nurse knows that if plasma cortisol levels fail to rise after an injection of cosyntropin, the pathology is:
1. idiopathic in nature.
2. at the level of the adrenal gland (primary adrenocortical insufficiency).
3. at the level of the hypothalamus.
4. at the level of the pituitary (secondary adrenocortical insufficiency).
Correct Answer: 2
Rationale 1: Failure of the plasma cortisol levels to rise does not mean that the pathology is idiopathic in nature.
Rationale 2: If plasma cortisol levels fail to rise after an injection of cosyntropin, the pathology is at the level of the adrenal gland (primary).
Rationale 3: Failure of the plasma cortisol levels to rise does not mean that the pathology is at the level of the hypothalamus.
Rationale 4: Failure of the plasma cortisol levels to rise does not mean that the pathology is at the level of the pituitary.
Global Rationale: If plasma cortisol levels fail to rise after an injection of cosyntropin, the pathology is at the level of the adrenal gland (primary). If the levels do rise the pathology is at the level of the hypothalamus or pituitary gland. The test does not determine if the disorder is idiopathic.
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