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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 ...
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.
When compared to insulin tolerance testing [11] and the high-dose ACTH test, this test allows for a more accurate identification of patients with secondary adrenal insufficiency. [12] Blood chemistry tests may reveal mild hypoglycemia, hyponatremia, normal-to-high potassium levels, slight anemia, lymphocytosis, and eosinophilia. [2]
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 ...
Adrenal crisis is a serious, life-threatening complication of adrenal insufficiency. Hypotension , or hypovolemic shock , is the main symptom of adrenal crisis, other indications and symptoms include weakness , anorexia , nausea , vomiting, fever, fatigue , abnormal electrolytes , confusion , and coma. [ 19 ]
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