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Evaluation of the response to ACTH in adrenal insufficiency

Lynnette K Nieman, MD
Section Editor
André Lacroix, MD
Deputy Editor
Kathryn A Martin, MD


Measurements of early morning (eg, 6 to 8 AM) serum cortisol and 24-hour urinary steroid excretion can suggest the diagnosis of adrenal insufficiency. (See "Diagnosis of adrenal insufficiency in adults".)

However, these measurements often cannot establish the presence or absence of adrenal insufficiency and cannot distinguish among the three disturbances in the hypothalamic-pituitary-adrenal (HPA) axis that can cause deficient cortisol secretion:

A primary adrenal disorder resulting in deficiency of cortisol (primary adrenal insufficiency or Addison's disease).

A pituitary disorder resulting in deficiency of corticotropin (ACTH) secretion (secondary adrenal insufficiency).

A hypothalamic disorder resulting in deficiency of corticotropin-releasing hormone (CRH) and secondarily of ACTH (tertiary adrenal insufficiency).


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Literature review current through: Sep 2016. | This topic last updated: Oct 29, 2014.
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