Basic principles in the laboratory evaluation of adrenocortical function
- Lynnette K Nieman, MD
Lynnette K Nieman, MD
- Section Editor — Adrenal Disease
- Senior Investigator
- Bethesda, MD
The adrenal cortex consists of three functional zones [1,2]:
●The zona glomerulosa, which secretes aldosterone and is primarily under the control of the renin-angiotensin system
●The zona fasciculata, which secretes cortisol and is regulated by the corticotropin-releasing hormone (CRH)-corticotropin (ACTH) system
●The zona reticularis, which secretes dehydroepiandrosterone (DHEA), DHEA sulfate, and smaller amounts of androstenedione, testosterone, and other 19-carbon steroids and is under the control of ACTH and perhaps other proopiomelanocortin (POMC)-derived peptides
Consequently, evaluation of adrenal function requires measurement of the relevant adrenal hormones and their metabolites and sometimes of the secretagogues (ACTH levels for cortisol or renin activity or concentration for aldosterone) that regulate their secretion.
- Miller WL. Steroidogenic enzymes. Endocr Dev 2008; 13:1.
- Arlt W, Stewart PM. Adrenal corticosteroid biosynthesis, metabolism, and action. Endocrinol Metab Clin North Am 2005; 34:293.
- Klose M, Lange M, Rasmussen AK, et al. Factors influencing the adrenocorticotropin test: role of contemporary cortisol assays, body composition, and oral contraceptive agents. J Clin Endocrinol Metab 2007; 92:1326.
- Hamrahian AH, Oseni TS, Arafah BM. Measurements of serum free cortisol in critically ill patients. N Engl J Med 2004; 350:1629.