Secondary adrenal insufficiency laboratory findings: Difference between revisions
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==Overview== | ==Overview== | ||
An elevated/reduced concentration of serum/blood/urinary/CSF/other [lab test] is diagnostic of [disease name]. | |||
OR | |||
Laboratory findings consistent with the diagnosis of [disease name] include [abnormal test 1], [abnormal test 2], and [abnormal test 3]. | |||
OR | |||
[Test] is usually normal among patients with [disease name]. | |||
OR | |||
Some patients with [disease name] may have elevated/reduced concentration of [test], which is usually suggestive of [progression/complication]. | |||
OR | |||
There are no diagnostic laboratory findings associated with [disease name]. | |||
==Laboratory Findings== | |||
*There are no diagnostic laboratory findings associated with [disease name]. | |||
OR | |||
*An elevated/reduced concentration of serum/blood/urinary/CSF/other [lab test] is diagnostic of [disease name]. | |||
*[Test] is usually normal among patients with [disease name]. | |||
*Laboratory findings consistent with the diagnosis of [disease name] include | |||
**[Abnormal test 1] | |||
**[Abnormal test 2] | |||
**[Abnormal test 3] | |||
*Some patients with [disease name] may have elevated/reduced concentration of [test], which is usually suggestive of [progression/complication]. | |||
===Laboratory Findings=== | ===Laboratory Findings=== | ||
Revision as of 13:45, 23 August 2017
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Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]
Overview
An elevated/reduced concentration of serum/blood/urinary/CSF/other [lab test] is diagnostic of [disease name].
OR
Laboratory findings consistent with the diagnosis of [disease name] include [abnormal test 1], [abnormal test 2], and [abnormal test 3].
OR
[Test] is usually normal among patients with [disease name].
OR
Some patients with [disease name] may have elevated/reduced concentration of [test], which is usually suggestive of [progression/complication].
OR
There are no diagnostic laboratory findings associated with [disease name].
Laboratory Findings
- There are no diagnostic laboratory findings associated with [disease name].
OR
- An elevated/reduced concentration of serum/blood/urinary/CSF/other [lab test] is diagnostic of [disease name].
- [Test] is usually normal among patients with [disease name].
- Laboratory findings consistent with the diagnosis of [disease name] include
- [Abnormal test 1]
- [Abnormal test 2]
- [Abnormal test 3]
- Some patients with [disease name] may have elevated/reduced concentration of [test], which is usually suggestive of [progression/complication].
Laboratory Findings
ACTH Stimulation Test
If the person is in adrenal crisis, the ACTH stimulation test[1] may be given. If not in crisis, cortisol, ACTH, aldosterone, renin, potassium and sodium are tested from a blood sample before the decision is made if the ACTH stimulation test needs to be performed. X-rays or CT of the adrenals may also be done. The best test for adrenal insufficiency of autoimmune origin, representing more than ninety percent of all cases in a Western population, is measurement of 21-hydroxylase autoantibodies.
| Source of pathology | CRH | ACTH | DHEA | DHEA-S | cortisol | aldosterone | renin | Na | K | Causes5 |
| hypothalamus (tertiary)1 |
low | low | low | low | low3 | low | low | low | low | tumor of the hypothalamus (adenoma), antibodies, environment (i.e. toxins), head injury |
| pituitary (secondary) |
high2 | low | low | low | low3 | low | low | low | low | tumor of the pituitary (adenoma), antibodies, environment, head injury, surgical removal6, Sheehan's syndrome |
| adrenal glands (primary)7 |
high | high | high | high | low4 | low | high | low | high | tumor of the adrenal (adenoma), stress, antibodies, environment, Addison's Disease, trauma, surgical removal (resection), miliary tuberculosis of the adrenal |
| 1 | Automatically includes diagnosis of secondary (hypopituitarism) |
| 2 | Only if CRH production in the hypothalamus is intact |
| 3 | Value doubles or more in stimulation |
| 4 | Value less than doubles in stimulation |
| 5 | Most common, does not include all possible causes |
| 6 | Usually because of very large tumor (macroadenoma) |
| 7 | Includes Addison's disease |
Routine Investigations
- Complete blood count and differential count - Eosinophilia and lymphocytosis (increased number of eosinophils or lymphocytes, two types of white blood cells). Normocytic anemia may be present.
- Serum ACTH levels - elevated in primary adrenal insufficiency and decreased in secondary form.
- Hypoglycemia - low blood sugar (worse in children)
- Serum electrolytes:
- Hyponatraemia - (low blood sodium levels)
- Hyperkalemia - (raised blood potassium levels), due to loss of production of the hormone aldosterone
- Mild hypercalcemia - in 20% patients
- Mild non–anion-gap metabolic acidosis
- Serum cortisol - decreased (<25mcg/dL)
- Urine and sweat sodium - elevated
- Elevated BUN and creatinine - when hypovolemia is the cause.
- Prolactin - mild elevation may be present.