Adrenal Insufficiency Diagnosis Algorithm Clinical features: - Weight loss, anorexia, Weakness, fatigue, GI distress - Hypotension, shock, orthostasis - Hyperpigmented skin (due to high ACTH stimulating melanocytes, only seen in PRIMARY adrenal insufficiency) - Unexplained hypoglycemia, Hyponatremia, hyperkalemia, eosinophilia Diagnostic findings (see algorithm): - AM serum cortisol (around 6-8AM) – if value is < 3, strongly suggestive of adrenal insufficiency; if > 18, adrenal insufficiency unlikely - If serum cortisol borderline/inconclusive (3-18), proceed with cosyntropin stimulation test: Steroids that DO not interact with stim test - dexamethasone - fludrocortisone #Adrenal #Insufficiency #Diagnosis #Algorithm #Cosyntropin #Stimulation #StimTest #Endocrinology
