Laboratory Tests

• The unstimulated serum cortisol and rapid ACTH stimulation tests are useful in the diagnosis of adrenal crisis (Table 45-2). The insulin tolerance test is contraindicated due to pre-existing hypoglycemia. The metyrapone test is also contraindicated since metyrapone inhibits cortisol production.

Note: Due to the life-threatening nature of this condition, empiric treatment should be started before laboratory confirmation in patients who present with the clinical picture of an acute adrenal crisis.

Table 45-2 Tests for Diagnosing Adrenal Insufficiency




FJndFng In Adrenal Intuffldency

Comments imct ni ng and D lagnistk Test j for Adrenal Iniuff k leiKy yrmimulaied tit um ttiimJ moJiitfCiiiCiH

ftjptd stlntailalkm res! (JIMJ wllefl ctHym ropin mrmiadM

insulin «Heran«

test llnudin injjc«) hypoqtywriU led

Mfuyjie Strum «yiliol iÖ-öj nwHjbcs JII:L"I rtrinliteflnj fosyntropln KOmftjIV

Administer In^jRnJV to Induce liytwgll^tmiJ mwvure scrum found

VHumcnfirvH level paAiai [he wrty mo<nin(t inc«»4cd CjOI riiCJ wcirtkvi in normal individuals

In <«(WTiKiC> ACTH si imulatlon tXll nut Irl idrcfdl


(vulmfos abilityof tiiliif Hi'A jxis w respond to streu (liypoglytcfmd)

Serum rcmisnl nie.irei liun 16 mctjAil W97 nrinil/|) is nCKrti.ll Serum roinsol less l Inn S mitpUl (Si mnoi/L} is indn-iciue of 3(Jl*nl Insuflktency ierurm cexüvoi concofaralion less tlun IILmC9ML.(M7 rirnoVL)

Serum toMiaoi «MeHtticri kiH than IH mcgAA (-ID/ r»rtiSt/U is indkitm: Of s«orKiiay Imuffcieney

Used ssa ffcneffll inlrial vrwriiij teic for (he presence ufl adrerul iroufk »¡cy. tvj&j jie iHui in coniuiK (¡Oft wii h those ijom Iheothet lests

Liwd ¿s He («*) JUrtUiO wir ibf dtigfKKiiritj fiifiury adrenal irrtiifinTii >■ Fdlsii nuidtlvx1 results mdy occut if (twi ACTH dlfclinOf ll ef «CP* Oftj^ Ktt tlun I month} Mliöuyh no I wkJ.^ jiiOuDCtl. J kw ttwe [I mcc|) ACTl H Stimulation lest has Leen uselrf ior lhe diagnosis of pdi1>al üdlifUl Insufficiency If moaned vmm cuvtisol mncwKlraiicn is kw, mwyjte pldsma ACTH, Jtixiwtxv. JiX) rtnln to drfüerenluäle between primary .md vtmxiiryui lerlijry ocMeml Insufficiency (Me tvt>«)

li It*.1 lesultoi the rjpid ttll H stimulation («1 iMj c* lhe overnlghl nvtyrapone lest Is slill rn-Tdttl lötvdluMS ic SttöKldry AiiifyJinsuHiCPtirRy lheInsulin (oterante Ies1 kconwJwed the ii.jhl

[>emlghi metyraporu WE


^ympinmatlc hypoglycemia (confirm Uiat blood glucose ü kfis tfidii flOmg/KIL \2-22 mrnol/ljf

Administer metyTapcr» at inkJiiighH Chen measure itrum Cortisol it&jwthc new day f^eryrsporif- Inhibits Cortisol synthesis. Lis adrnmliltaL iun IqkJs to-rise in levels of ACTIi aod thepfKuisoof aJctfed, Paiieras y.-n h adrenal insufllcientydo rat exhibit this

Nor mal reippnw I? a decrease In serum Cortisol 1o Ich 1f»an S mtgrtJL (136 mrnolvl) and an ¡ inllie Cortisol (ireairKir to monfThsfi 1 mccydL 4193 nmol/li flesfcnse not seen in secondary adrenal insufltiency

Plasma ACTH cjoncontrison

Measure plasma ACfH

In primary adrenal prriufiici^rtty, hypoccfiöJism IWJS ro elcufid plasma AjCTH concerHraticin via positive HPAaxfc foodlMCk

Primary adrenal insufficient y: tfcvdWd plasma ftCTH Secondary or terrify adrenal Insufüclency: plasma ACTH tow a inappropnately normal

Ptasma jfcJovlfiox-cnncvntranlcn

Plasma renin ttXKinträiiön Of XlHrtty

Measure plasma

Patients with

Pmmaiy adrenal


primary jdiervji

in^yffii isrtiy: lijw

from same


plasma aldosterone


may (Bdjciianca

Secondary or tt*Hary

iimples ,TL

.1 nfitVif linn in

■fcliin.ll imicHli ifTH' y:

those used



In flCTH


COfiCiMiilioii Ii usually

stimulation Dgieatrt 1han a


equal to S n^VJL




PjTtsiy adrenal

pi«™ ienin


insuffcieiitf elevated


In piiinaryddrcftil

pl~1<jTl.l KHKil

or activity

Insullkiency but k

Secondary or to liary

USuillytvji rwwnt

XliOrtil inSn/ilcietXy;

In secondary or

p4asma renin

(t«lijry jdienal

LUrwI'diO" or


activity is usually

Contrgiodlcired In patient* with a seizure hi-iccwy. older than (iiJ yeais, of with cardiovascular oi ceictxovasculdr disease

RBfjjiiesibse inidtai yjpwrtston

ContrjindicatMl iriiclienal CiiSiS

Distinguishes between normal Individuals and patients with sec ondai y adianil insufficiency

Centra ^idkaltt) inadicnal uisis

Tests for Differential Diagnosis of Primary, Secondary, and Tertiary Adrenal Insufficiency

Evaluate resu'1 of test in combination wirh lhost from Hie plasmd akfcweBnaand plaiffia renin lttts

Evaluate result <J test ¿lcombiriaLiori With tlvjie'r<?m the 11■ J-I in I II jm £ plasma mm Inn

Evaluate ruiult of lest rnconlwvifiori with ih«e irotift rhe ptäirini a£Th mki piauna flklosfletijne concentration Tpsti

^TH. adicnocorticcHropic liormono-or corticotropin; CHH, codicotropiri releasing hormone; HltMrypotfulamic-piluilary ¿JrenJ. Fiom fiefs. J, S.

Table 45-3 Pharmacologic Characteristics of Commonly Used Glucocorticoids

f tlim*[(d Ponnty RrliH»r lo H.ydr$(UJl<njn(

Glucocorticoid iAnti-lnfl^mmatorv)

Mlneralocertkoid liodium-

Equivalent Daie

Glucocorticoid Activity

flttjinmgl Activity


Short Acting ftUtf-Lrt* Leu (hwi U houri)

HydracaUBcrw 1





Intermediate Acting 1 Half-Life 12-16 hour:)

fYedni-Lone 4



p^dnisotonc 4



MethylptednKolone 5-

Less ttunfluEH



Lp-k rtun i)(lt


Long Actl ng [Half- Life Greater Than 48 hourc}

Qeiameitwöne is

LeK rtun am

OetameDwjone 30-40

L«4 trwiiacn

Lower Your Cholesterol In Just 33 Days

Lower Your Cholesterol In Just 33 Days

Discover secrets, myths, truths, lies and strategies for dealing effectively with cholesterol, now and forever! Uncover techniques, remedies and alternative for lowering your cholesterol quickly and significantly in just ONE MONTH! Find insights into the screenings, meanings and numbers involved in lowering cholesterol and the implications, consideration it has for your lifestyle and future!

Get My Free Ebook

Post a comment