Differential Diagnosis
Primary adrenal insufficiency
Secondary adrenal insufficiency with underlying disorder
Suggested Additional Lab Testing
Primary adrenal insufficiency
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Exogenous ACTH does not stimulate cortisol secretion, and the plasma ACTH is elevated.
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Serum aldosterone is low in cases in which destruction of the adrenal gland affects both cortisol and aldosterone production.
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Testing for antibodies against the adrenal cortex may reveal autoimmune adrenalitis as a cause of primary adrenal insufficiency.
Secondary adrenal insufficiency
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Low plasma ACTH, because the disorder originates in the hypothalamus or pituitary.
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Serum aldosterone is often normal but may be decreased if there is significant atrophy of the adrenal gland as a result of chronic lack of stimulation by ACTH.
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CRH stimulation test can distinguish between ACTH deficiency from pituitary and deficiency of CRH from hypothalamus.
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