endocrine and metabolic disorders
Secondary Adrenal Insufficiency
Diagnosis of Secondary Adrenal Insufficiency
Serum cortisol Serum adrenocorticotropic hormone (ACTH) ACTH stimulation testing Central nervous system imaging Tests to differentiate primary and secondary adrenal insufficiency are discussed under Diagnosis . Patients with confirmed secondary adrenal insufficiency (see table Adequacy of the Overview of the Endocrine System during tapering or after stopping long-term corticosteroid treatment can be determined by injecting Thecorticotropin-releasing hormone (CRH) test can be used to distinguish between hypothalamic and pituitary causes but is rarely used in clinical practice. After administration of CRH 100 mcg (or 1 mcg/kg) IV, the normal response is a rise of plasma ACTH of 30 to 40 pg/mL (6.6 to 8.8 pmol/L); patients with pituitary failure do not respond, whereas those with hypothalamic disease usually do. 