Adrenal atrophy laboratory findings
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Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]; Associate Editor(s)-in-Chief: Maryam Hadipour, M.D.[2]
Overview
The labs include random cortisol, serum ACTH, aldosterone and renin, potassium and sodium, ACTH stimulation test and CRH stimulation test.
Laboratory findings
The labs to be run should include:
In the first line, the serum cortisol level is expected to be from 10 to 20 mcg/dL (275 to 555 nmol/L) in the morning (6 AM) and the morning cortisol levels, lower than 3 mcg/dL (80 nmol/L) are highly suggestive for a form of adrenal insufficiency, including adrenal atrophy. On the other hand, the salivary cortisol concentration above 5.8 ng/mL (16 nmol/L) excludes adrenal insufficiencies, and concentrations below 1.8 ng/mL (5 nmol/L) is highly suggestive for adrenal atrophy or other forms of adrenal insufficiency. However, in order to check the functionality of the Hypothalamic Pituitary Adrenal Axis the entire axis must be tested by ACTH stimulation test and CRH stimulation test. In primary adrenal insufficiency, the 8 AM plasma ACTH concentration is high, sometimes as high as or higher than 4000 pg/mL (880 pmol/L). The mineralocorticoids, including aldosterone level are low in adrenal atrophy but the renin level are usually higher than the normal range, due to the absence of negative feedback. As a result, low sodium and high potassium levels may occur in patients. Potassium levels higher than 5.5 to 6.5 mmol/L may yield to cardiac arrhythmia or arrest. The ACTH stimulation test consists of injecting a small amount of synthetic ACTH, and the amount of [[cortisol] (and sometimes aldosterone) that the adrenals produce in response is then measured. A normal response to the high-dose (250 mcg as an intravenous [IV] bolus) ACTH stimulation test is a rise in serum cortisol concentration after either 30 or 60 minutes to a peak of ≥18 to 20 mcg/dL (500 to 550 nmol/L). The low-dose (1 mcg as an IV bolus) ACTH stimulation test criteria for a normal cortisol response after 20 or 30 minutes are more variable: 17 to 22.5 mcg/dL (400 to 620 nmol/L). Normal response strongly rules out adrenal atrophy and other forms of secondary adrenal insufficiency should be considered.[1][2]
References
- ↑ Abdu TA, Elhadd TA, Neary R, Clayton RN (March 1999). "Comparison of the low dose short synacthen test (1 microg), the conventional dose short synacthen test (250 microg), and the insulin tolerance test for assessment of the hypothalamo-pituitary-adrenal axis in patients with pituitary disease". J Clin Endocrinol Metab. 84 (3): 838–43. doi:10.1210/jcem.84.3.5535. PMID 10084558.
- ↑ Husebye ES, Perheentupa J, Rautemaa R, Kämpe O (May 2009). "Clinical manifestations and management of patients with autoimmune polyendocrine syndrome type I". J Intern Med. 265 (5): 514–29. doi:10.1111/j.1365-2796.2009.02090.x. PMID 19382991.