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Diagnostic evaluation for suspected adrenal insufficiency. The first step is to perform a rapid ACTH stimulation test to ascertain whether there is adrenal insufficiency. Then, the plasma ACTH level differentiates between primary and secondary adrenal insufficiency. In cases where the serum cortisol after ACTH stimulation is normal, but there is a high suspicion of adrenal insufficiency or where it may be of recent onset (eg, with pituitary apoplexy), an insulin tolerance test is conducted. Alternatively, a measurement of DHEAS, which like cortisol is dependent on the action of ACTH, or a metyrapone test can be helpful. Boxes enclose clinical diagnoses, and ovals indicate diagnostic tests. Source: Disorders of the Adrenal Cortex, Pathophysiology of Disease: An Introduction to Clinical Medicine, 7e Citation: Hammer GD, McPhee SJ. Pathophysiology of Disease: An Introduction to Clinical Medicine, 7e; 2013 Available at: http://mhmedical.com/ Accessed: August 12, 2017 Copyright © 2017 McGraw-Hill Education. All rights reserved
