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Adrenal Insufficiency Differential Diagnosis Algorithm Clinical suspicion: Weakness, fatigue, nausea, musculoskeletal pain, dizziness, volume depletion, abdominal pain,
Adrenal Insufficiency ... Adrenocorticotropic hormone (ACTH ... Baseline plasma ACTH ... High baseline ACTH ... normal baseline ACTH
Hypercortisolism (Cushing syndrome) - Simplified Differential Diagnosis Algorithm Exogenous (ACTH-independent) Endogenous • ACTH-dependent: - ACTH-secreting
Endogenous • ACTH-dependent ... : - ACTH-secreting ... Disease) - ACTH-secreting ... : - Adrenal ... hyperplasia - Adrenal
Primary Adrenal Insufficiency: • ACTH stimulation test - Synthetic ACTH does not stimulate cortisol secretion because
Insufficiency: • ACTH ... test - Synthetic ACTH ... by endogenous ACTH ... Low • Plasma ACTH ... stimulation by ACTH
Diagnosis Adrenal Insufficiency - Algorithm Step 1) Screening Test: 6-8AM Cortisol Level - Early morning cortisol levels
Diagnosis Adrenal ... determines if the adrenal ... - Check ACTH ... . problem with adrenal ... gland) #Adrenal
Primary Adrenal Insufficiency Addison's Disease - Damage of the adrenal glands with lack of cortisol, androgens and
AM cortisol and ACTH ... AI present - ACTH ... Administer 250 mcg ACTH ... AI present - ACTH ... DEXAMETHASONE - ACTH
Adrenal Insufficiency - Differential Diagnosis Workup Algorithm Primary Adrenal Insufficiency: • Autoimmune primary adrenal insufficiency • Adrenoleukodystrophy,
Adrenal Insufficiency ... Algorithm Primary Adrenal ... Autoimmune primary adrenal ... apoplexy • Isolated ACTH-deficiency ... Insufficiency #Adrenal
Primary vs Secondary Adrenal Insufficiency - Pathophysiology Primary AI = adrenal glands themselves are the problem. This
Primary vs Secondary Adrenal ... Pathophysiology Primary AI = adrenal ... be low, while ACTH ... Low ACTH leads to ... limited adrenal
Causes of Adrenal Insufficiency - Differential Diagnosis Algorithm ACTH-Dependent (Secondary): • Pituitary Dysfunction • Hypothalamic Dysfunction ACTH-Independent (Primary):
Causes of Adrenal ... Diagnosis Algorithm ACTH-Dependent ... Hypothalamic Dysfunction ACTH-Independent ... Thrombophilia (adrenal ... Medicine @SCVMCMed #Adrenal
Adrenal Insufficiency Diagnosis Algorithm - Evaluation of HPA Axis Response to ACTH Early am cortisol < 3
Adrenal Insufficiency ... Axis Response to ACTH ... indicates normal adrenal ... secondary AI Measure ACTH ... tertiary AI #Adrenal
Algorithm for the diagnosis of adrenal insufficiency (AI). The standard cosyntropin stimulation test (CST) may be
the diagnosis of adrenal ... evaluation of adrenal ... ACTH, adrenocorticotropic ... Diagnosis #Endo #ACTH
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