Your doctor will begin by asking about your medical history and about any obvious symptoms you are experiencing. Tests that measure the levels of cortisol and aldosterone are used to make a definite diagnosis and include the following:. Once a diagnosis of adrenal insufficiency has been made, a computed tomography CT scan of the abdomen may be taken to see if the adrenal glands are diminished in size, reflecting destruction, or enlarged, reflecting infiltration by some independent disease process.
The scan also may show signs of calcium deposits, which may indicate previous exposure to tuberculosis. A tuberculin skin test may be used to address the latter possibility. A number of imaging tools may be used to examine the size and shape of the pituitary gland. Message If ARUP Consult does not answer your test selection and interpretation questions, or if you would like to suggest ways to improve content or usability, please send a message to the Consult editorial staff.
ARUP will only use your email address to respond to your feedback. See the ARUP privacy policy for more information regarding email use. Leave this field blank. Quick Answers for Clinicians Who should be tested for adrenal insufficiency? What are the recommended tests for evaluation of adrenal insufficiency?
Which testing algorithms are related to this topic? Adrenal Insufficiency Testing Algorithm. Indications for Testing The early symptoms of adrenal insufficiency are nonspecific, which may lead to delayed diagnosis. They include: Weakness Fatigue Loss of appetite and weight loss Nausea Musculoskeletal pain Dizziness Symptoms suggestive of PAI include: Extracellular fluid volume reduction Abdominal pain Hypotension Hyponatremia Hyperkalemia Fever Hyperpigmentation Hypoglycemia, especially in pediatric patients If untreated, patients may experience adrenal crisis and death.
Clinicians should use a low threshold for diagnostic evaluation in : Acutely ill patients Patients with predisposing factors eg, type 1 diabetes mellitus , autoimmune gastritis, HIV , tuberculosis Patients taking certain medications, such as adrenal enzyme inhibitors, phenytoin, and St. Additional Testing Once a diagnosis of adrenal insufficiency has been established, further testing should be performed to identify the underlying cause of the insufficiency and determine other medical implications.
Aldosterone and Renin Testing Simultaneous measurement of aldosterone and plasma renin is recommended in cases of adrenal insufficiency to determine whether the patient has mineralocorticoid deficiency. Pituitary Function Evaluation In cases of secondary adrenal insufficiency, assess the hypothalamic-pituitary axis with imaging. Monitoring Monitoring of glucocorticoid replacement should be based on clinical assessment; hormonal monitoring is generally not recommended. Adrenocorticotropic Hormone Stimulation, 0 Minutes Adrenocorticotropic Hormone Stimulation, 30 Minutes Adrenocorticotropic Hormone Stimulation, 60 Minutes Additional Testing for Diagnosis of Adrenal Insufficiency.
Adrenocorticotropic Hormone Additional Testing. Testing for Mineralocorticoid Deficiency. Aldosterone and Renin, Direct with Ratio Testing for Etiology of Adrenal Insufficiency. Monitoring Tests. Electrolyte Panel Dehydroepiandrosterone Sulfate, Serum Related Tests. Aldosterone 30 Minute The ACTH test may not be accurate in people who have had secondary adrenal insufficiency for a shorter time because their adrenal glands have not yet shrunk and can still respond to ACTH.
A health care professional will give you an IV injection of the hormone insulin , which lowers your levels of blood glucose. The dose is high enough to cause hypoglycemia, which occurs when your blood glucose level drops too low. Hypoglycemia causes physical stress, which normally triggers the pituitary to make more ACTH.
A health care professional will draw your blood at the beginning of the test and again every half hour during the next 2 hours. The ITT is the most reliable test to diagnose secondary adrenal insufficiency.
This test can also tell secondary from tertiary adrenal insufficiency. A health care professional will give you an IV injection of CRH and take samples of your blood before and 30, 60, 90, and minutes after the injection to measure ACTH levels.
This result shows secondary adrenal insufficiency. A slow rise in ACTH levels suggests tertiary adrenal insufficiency. Once doctors diagnosis and identify the type of adrenal insufficiency, they may use blood and imaging tests to find the exact cause.
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