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To determine the origin of dysfunction, the ACTH stimulation test is the best initial test as it can differentiate between primary and secondary adrenal insufficiency. [2] If cortisol levels remain low following ACTH stimulation, then the diagnosis is primary adrenal insufficiency. [2]
If the short test is abnormal, the long test is used to differentiate between primary adrenal insufficiency and secondary adrenocortical insufficiency. [28] The long test uses 1 mg tetracosactide (intramuscular). Blood is taken 1, 4, 8, and 24 hours later. Normal plasma cortisol level should reach 1,000 nmol/L by 4 hours.
The test is extremely sensitive (97% at 95% specificity) to primary adrenal insufficiency, but less so to secondary adrenal insufficiency (57–61% at 95% specificity); while secondary adrenal insufficiency may thus be dismissed by some interpreters on the basis of the test, additional testing may be called for if the probability of secondary ...
Diseases classified as primary adrenal insufficiency (including Addison's disease and genetic causes) directly affect the adrenal cortex. If a problem that affects the hypothalamic–pituitary–adrenal axis arises outside the gland, it is a secondary adrenal insufficiency. [46]
The U.S. National Institutes of Health says blood tests are the gold standard for diagnosing adrenal insufficiency, but a 2023 study from researchers in the U.K. found that saliva tests are not ...
Primary adrenal insufficiency; Congenital adrenal hyperplasia (21 but not 11β and 17) Aldosterone synthase deficiency; Secondary aldosterone deficiency; Secondary adrenal insufficiency; Diseases of the pituitary or hypothalamus; Hyporeninemic hypoaldosteronism (due to decreased angiotensin 2 production as well as intra-adrenal dysfunction) [4]
This is because secondary adrenal insufficiency is related to the pituitary gland and its ability to produce ACTH, which is not a hormone that regulates the production of Aldosterone from the adrenal gland. However, primary adrenal insufficiency is caused by damage to the adrenal glands, which leads to underproduction of the hormones. Primary ...
In secondary adrenal insufficiency, hyponatremia results from decreased kidney excretion of electrolyte-free water and the inability to suppress vasopressin. [5] Hyponatremia in primary adrenal insufficiency is caused by concurrent aldosterone deficiency, resulting in volume depletion, natriuresis, and hyperkalemia. Hypercalcemia is triggered ...