Is a Specialist Needed for an Adrenal Insufficiency Diagnosis?

To start the diagnosis process, you will need to consult an endocrinologist if your primary care physician believes you may have adrenal insufficiency.

An illness of the adrenal glands is called adrenal insufficiency. It occurs when your body doesn't produce enough of the hormones your glands require to function. Symptom management is aided by treatment.

The first step in creating a treatment plan that suits you is getting a diagnosis.

What doctor do you need to see for an adrenal insufficiency diagnosis?

Your primary care physician would probably recommend that you consult an endocrinologist if they believe you may have adrenal insufficiency.

Endocrinologists are experts in disorders affecting the hormones in the body. They can oversee your care and make the diagnosis of adrenal insufficiency.

How is adrenal insufficiency diagnosed?

An endocrinologist will first go over your medical history and symptoms. Early on in adrenal insufficiency, symptoms frequently come and go and worsen gradually. Diagnosis may become challenging as a result.

The following tests may be performed to help confirm the diagnosis:

Morning serum cortisol test

This test measures your blood's baseline cortisol level. A low cortisol level indicates insufficient adrenal glands.

Adrenocorticotropic hormone (ACTH) stimulation test

An intravenous or intramuscular injection of synthetic ACTH, a hormone produced naturally by the adrenal glands, is used in an ACTH stimulation test to measure your body's reaction.

Following the ACTH injection, cortisol levels rise in people with normal adrenal function. Cortisol levels usually do not rise in people with adrenal insufficiency.

Insulin tolerance test (ITT)

You will have an IV insulin injection during this test, and for the next two hours, your blood will be collected every 30 minutes.

High levels of cortisol are produced by a functioning pituitary gland in response to insulin, whereas low levels of cortisol may indicate adrenal insufficiency.

If your ACTH values are inconsistent with your diagnosis or if your endocrinologist thinks a pituitary gland issue is the cause of your secondary adrenal insufficiency, you may be scheduled for an ITT.

Corticotropin-releasing hormone (CRH) stimulation test

If you get unclear results from other tests, you may be scheduled for a CRH stimulation test.

You will have an IV injection of CRH during this test, and over the next two hours, your blood will be taken every 30 minutes. Insufficient adrenal gland function may be indicated if your levels of ACTH do not increase.

Finding the cause of adrenal insufficiency

Three basic kinds of adrenal insufficiency exist:

• Primary adrenal insufficiency: This kind, sometimes known as Addison disease, develops when the illness has no underlying cause.
• Secondary adrenal insufficiency: This kind of results from an additional condition.
• Tertiary adrenal insufficiency: This kind of happens when something interferes with the generation of CRH, which lowers pituitary function and ultimately lowers adrenal function.

When adrenal insufficiency is diagnosed, blood tests may be sufficient to determine the reason; however, further testing may be required. Imaging tests like MRIs and CT scans may fall under this category.

To identify tumours and other growths that may occasionally result in adrenal insufficiency, these scans can let doctors get a thorough look at your pituitary gland, adrenal gland, and the area of your brain that regulates the synthesis of CRH.

What are the lab results for adrenal insufficiency?

Multiple tests are frequently required to diagnose adrenal insufficiency, therefore it's crucial to wait for a medical specialist to evaluate your data. Every test has several other factors to take into account, such as variations in test kinds and laboratory procedures.

A cortisol level below the normal range generally indicates adrenal insufficiency.

A cortisol level that doesn't rise over a specific point during ACTH simulation tests, which aim to raise cortisol levels in your body, may also indicate adrenal insufficiency.

What conditions mimic adrenal insufficiency?

Adrenal insufficiency's initial symptoms are hazy and frequently coincide with those of other illnesses. Misdiagnosis may result from this occasionally. Adrenal insufficiency is sometimes confused with or mimicked by other disorders.

The following illnesses frequently resemble adrenal insufficiency:

• chronic fatigue syndrome
• hypothyroidism
• chronic indigestion
• depression
• anxiety
• fibromyalgia

Takeaway

Treatments exist for adrenal insufficiency. Adrenal insufficiency can be diagnosed and treated by an endocrinologist.

Blood tests such as the CRH stimulation test, ITT test, and ACTH stimulation test are used to confirm a diagnosis.

To help identify the underlying cause of adrenal insufficiency, further testing, such as MRI and CT imaging, is occasionally utilised.

FAQs

What kind of doctor do you see for adrenal fatigue?

An endocrinologist

What is the ideal investigation for adrenal insufficiency?

salivary cortisol testing

Is adrenal insufficiency hard to diagnose?

Due to the gradual onset of symptoms, adrenal insufficiency can be difficult to detect in its early stages.

What doctor can diagnose Addison's disease?

A hospital hormone specialist (endocrinologist)