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Medicina & Laboratorio

2009, Number 05-06

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Medicina & Laboratorio 2009; 15 (05-06)

Dynamic testing in endocrinology: Adrenal insufficiency

Clara Arango Toro, Germán Campuzano Maya, Guillermo Latorre Sierra

Language: Spanish
References: 65
Page: 211-232
PDF size: 758.83 Kb.


ABSTRACT

The diagnosis of adrenal insufficiency is suspected by clinical findings and is confirmed by laboratory tests. Primary adrenal insufficiency is caused by a lesion in the adrenal glands, while secondary adrenal insufficiency may be caused by hypopituitarism due to hypothalamic-pituitary disease, or it may result from suppression of the hypothalamic- pituitary axis by steroids. Clinical findings of primary adrenal insufficiency include fatigue, anorexia, diarrhea, joint and muscle pain, and darkening of the skin. The clinical findings of secondary adrenal insufficiency are similar to that of primary adrenal insufficiency; however, there is no hyperpigmentation. The clinician is often faced with a patient presenting non-specific symptoms and the diagnosis of adrenal insufficiency may not be considered. An ideal screening test would be economic, convenient and safe, and have high sensitivity and specificity. Unfortunately, no available test meets all of these criteria. Measurement of basal cortisol is an inexpensive and convenient screening test that can include (if &# 3 μg/dL or ‹ 5 μg/dL, according to different authors) or exclude (if › 18 μg/dL) adrenal insufficiency; however, most patients will have intermediate values and will require dynamic testing. This module discusses the use of dynamic tests, including insulin tolerance test, metyrapone stimulation test, and cosyntropin stimulation test as inducers agents for cortisol secretion. Finally, an algorithm to study the patient with a possible diagnosis of adrenal insufficiency is presented.


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