Secondary adrenal insufficiency laboratory findings: Difference between revisions
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====Routine Investigations==== | ====Routine Investigations==== | ||
* [[Complete blood count]] and differential count - [[Eosinophilia]] | * [[Complete blood count]] and differential count - | ||
**[[Eosinophilia]] | |||
**[[Lymphocytosis]] | |||
**[[Normocytic anemia]] may be present. | |||
* Serum [[ACTH]] levels - elevated in primary adrenal insufficiency and decreased in secondary form. | * Serum [[ACTH]] levels - elevated in primary adrenal insufficiency and decreased in secondary form. | ||
* [[Hypoglycemia]] - | * [[Hypoglycemia]]<ref name="pmid3002680">{{cite journal |vauthors=Burke CW |title=Adrenocortical insufficiency |journal=Clin Endocrinol Metab |volume=14 |issue=4 |pages=947–76 |year=1985 |pmid=3002680 |doi= |url=}}</ref><ref name="pmid12456538">{{cite journal |vauthors=Todd GR, Acerini CL, Ross-Russell R, Zahra S, Warner JT, McCance D |title=Survey of adrenal crisis associated with inhaled corticosteroids in the United Kingdom |journal=Arch. Dis. Child. |volume=87 |issue=6 |pages=457–61 |year=2002 |pmid=12456538 |pmc=1755820 |doi= |url=}}</ref><ref name="pmid6276646">{{cite journal |vauthors=Stacpoole PW, Interlandi JW, Nicholson WE, Rabin D |title=Isolated ACTH deficiency: a heterogeneous disorder. Critical review and report of four new cases |journal=Medicine (Baltimore) |volume=61 |issue=1 |pages=13–24 |year=1982 |pmid=6276646 |doi= |url=}}</ref> | ||
* [[Serum electrolytes]]: | * [[Serum electrolytes]]: | ||
** [[Hyponatraemia]] - (low blood sodium levels) | ** [[Hyponatraemia]] - (low blood sodium levels)<ref name="pmid27271953">{{cite journal |vauthors=Cuesta M, Garrahy A, Slattery D, Gupta S, Hannon AM, Forde H, McGurren K, Sherlock M, Tormey W, Thompson CJ |title=The contribution of undiagnosed adrenal insufficiency to euvolaemic hyponatraemia: results of a large prospective single-centre study |journal=Clin. Endocrinol. (Oxf) |volume=85 |issue=6 |pages=836–844 |year=2016 |pmid=27271953 |doi=10.1111/cen.13128 |url=}}</ref> | ||
** [[Hyperkalemia]] - | ** [[Hyperkalemia]]- not present | ||
** Mild [[hypercalcemia]] - in 20% patients | ** Mild [[hypercalcemia]] - in 20% patients | ||
** Mild non–anion-gap [[metabolic acidosis]] | ** Mild non–anion-gap [[metabolic acidosis]] | ||
* Serum [[cortisol]] - decreased (<25mcg/dL) | * Serum [[cortisol]] - decreased (<25mcg/dL) | ||
* Urine and sweat [[sodium]] - elevated | * Urine and sweat [[sodium]] - elevated | ||
* Elevated [[BUN]] and [[creatinine]] - when [[hypovolemia]] is the cause. | * Azotemia- Elevated [[BUN]] and [[creatinine]] - when [[hypovolemia]] is the cause. | ||
* [[Prolactin]] - mild elevation may be present. | * [[Prolactin]] - mild elevation may be present. | ||
Revision as of 00:16, 10 October 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
- Lymphocytosis
- Normocytic anemia may be present.
- Serum ACTH levels - elevated in primary adrenal insufficiency and decreased in secondary form.
- Hypoglycemia[2][3][4]
- Serum electrolytes:
- Hyponatraemia - (low blood sodium levels)[5]
- Hyperkalemia- not present
- Mild hypercalcemia - in 20% patients
- Mild non–anion-gap metabolic acidosis
- Serum cortisol - decreased (<25mcg/dL)
- Urine and sweat sodium - elevated
- Azotemia- Elevated BUN and creatinine - when hypovolemia is the cause.
- Prolactin - mild elevation may be present.
References
- ↑ Henzen C (2011). "[Adrenal insufficiency--diagnosis and treatment in clinical practice]". Ther Umsch. 68 (6): 337–43. doi:10.1024/0040-5930/a000174. PMID 21656493. Unknown parameter
|month=ignored (help) - ↑ Burke CW (1985). "Adrenocortical insufficiency". Clin Endocrinol Metab. 14 (4): 947–76. PMID 3002680.
- ↑ Todd GR, Acerini CL, Ross-Russell R, Zahra S, Warner JT, McCance D (2002). "Survey of adrenal crisis associated with inhaled corticosteroids in the United Kingdom". Arch. Dis. Child. 87 (6): 457–61. PMC 1755820. PMID 12456538.
- ↑ Stacpoole PW, Interlandi JW, Nicholson WE, Rabin D (1982). "Isolated ACTH deficiency: a heterogeneous disorder. Critical review and report of four new cases". Medicine (Baltimore). 61 (1): 13–24. PMID 6276646.
- ↑ Cuesta M, Garrahy A, Slattery D, Gupta S, Hannon AM, Forde H, McGurren K, Sherlock M, Tormey W, Thompson CJ (2016). "The contribution of undiagnosed adrenal insufficiency to euvolaemic hyponatraemia: results of a large prospective single-centre study". Clin. Endocrinol. (Oxf). 85 (6): 836–844. doi:10.1111/cen.13128. PMID 27271953.