Dr. Gerald Diaz @GeraldMD
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Board Certified Internal Medicine Hospitalist, GrepMed Editor in Chief πŸ‡΅πŸ‡­ πŸ‡ΊπŸ‡Έ - Sign up for an account to like, bookmark and upload images to contribute to our community platform. Follow us on IG: https://www.instagram.com/grepmed/ | Twitter: https://twitter.com/grepmeded/
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Adrenal Insufficiency Differential Diagnosis Algorithm
Clinical suspicion: Weakness, fatigue, nausea, musculoskeletal pain, dizziness, volume depletion, abdominal pain,
Adrenal Insufficiency ... , hypotension, hyponatremia ... ACTH - Primary adrenal ... ACTH - Secondary adrenal ... #Algorithm #endocrinology
Adrenal Insufficiency Diagnosis Algorithm
Clinical features: 
 - Weight loss, anorexia, Weakness, fatigue, GI distress
 - Hypotension,
Adrenal Insufficiency ... Diagnosis Algorithm ... seen in PRIMARY adrenal ... hypoglycemia, Hyponatremia ... suggestive of adrenal
Hypernatremia Diagnosis and Workup

Step 1 . Repeat the sodium concentration.
Step 2.  Check plasma osmolality.
NORMAL PLASMA
Hypernatremia Diagnosis ... mmol/L - true hyponatremia ... hypothyroidism β€’ adrenal ... #Diagnosis #Workup ... #Algorithm #Nephrology
Adrenal Insufficiency - Differential Diagnosis Workup Algorithm
Primary Adrenal Insufficiency:
 β€’ Autoimmune primary adrenal insufficiency
 β€’ Adrenoleukodystrophy,
Adrenal Insufficiency ... - Differential Diagnosis ... Workup Algorithm ... Primary Adrenal ... #endocrinology
Hyponatremia - Differential Diagnosis Algorithm
ADH Independent:
 β€’ Tea and Toast Syndrome, Beer Potomania - Low solute
Hyponatremia - Differential ... Diagnosis Algorithm ... Hypothyroidism, adrenal ... #Differential #Diagnosis ... #Algorithm #causes
Causes of Hyponatremia - Differential Diagnosis Algorithm
Syndrome of Inappropriate ADH - Euvolemic; no physiologic stimulus to
Causes of Hyponatremia ... - Differential Diagnosis ... Algorithm Syndrome ... Hypothyroidism β€’ Adrenal ... #Algorithm #Causes
Adrenal Insufficiency Algorithm - Cosyntropin Stimulation Test
T-1m: Baseline cortisol drawn
T0: 250 Β΅g cosyntropin given IV
T30m: Repeat
Adrenal Insufficiency ... Algorithm - Cosyntropin ... BCM_InternalMed #Adrenal ... Insufficiency #Testing #Algorithm ... #Stimulation #endocrinology
Causes of Adrenal Insufficiency - Differential Diagnosis Algorithm
ACTH-Dependent (Secondary):
 β€’ Pituitary Dysfunction
 β€’ Hypothalamic Dysfunction
ACTH-Independent (Primary):
Causes of Adrenal ... - Differential Diagnosis ... Thrombophilia (adrenal ... Medicine @SCVMCMed #Adrenal ... #endocrinology
Adrenal Insufficiency Diagnosis Algorithm
Test 1: Baseline AM Cortisol 
 - Beware of major normal value
 -
Adrenal Insufficiency ... Diagnosis Algorithm ... BCM_InternalMed #Adrenal ... Insufficiency #Diagnosis ... #Algorithm #endocrinology
Adrenal Insufficiency Diagnosis Algorithm - Evaluation of HPA Axis Response to ACTH

Early am cortisol < 3
Adrenal Insufficiency ... Diagnosis Algorithm ... indicates normal adrenal ... tertiary AI #Adrenal ... Stimulation #Test #Endocrinology