Adrenal Insufficiency Diagnosis Algorithm

Clinical features: 

 - Weight loss, anorexia, Weakness, fatigue, GI distress

 - Hypotension, shock, orthostasis

 - Hyperpigmented skin (due to high ACTH stimulating melanocytes, only seen in PRIMARY adrenal insufficiency)

 - Unexplained hypoglycemia, Hyponatremia, hyperkalemia, eosinophilia

Diagnostic findings (see algorithm):

 - AM serum cortisol (around 6-8AM) – if value is < 3, strongly suggestive of adrenal insufficiency; if > 18, adrenal insufficiency unlikely

 - If serum cortisol borderline/inconclusive (3-18), proceed with cosyntropin stimulation test:

Steroids that DO not interact with stim test

 - dexamethasone

 - fludrocortisone



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