Adrenal crisis Adrenal insufficiency Endocrinology Physiotherapy

Diagnosis of Acute Adrenal Crisis or Insufficiency

In this article we will discuss the Diagnosis of Acute Adrenal Crisis or Insufficiency

In this article, we will discuss the Diagnosis of Acute Adrenal Crisis or Insufficiency. So, let’s get started.


  • Eosinophil count may be high
  • Plasma cortisol (morning and evening): It will be low (<3 mcg/dl at 8 am). A plasma cortisol in normal range in acutely ill patient does not rule out adrenal insufficiency
  • Short one hour ACTH (cosyntropin) stimulation test: In adrenal insufficiency, serum cortisol does not rise in response to ACTH (i.e. cortisol level remains below the cut off limit of 500-550 nmol/L sampled one hour after ACTH stimulation)
  • ACTH levels will help to diagnose whether adrenal insufficiency is primary (high level) or secondary (low level). Low plasma cortisol with high level ACTH simultaneously suggests primary adrenal insufficiency/crisis
  • Serum DHEA levels <1000 ng/ml in all patients with Addison’s disease
  • Serum Na+ and K+ levels: Serum Na+ is normal to low and K+ is high. Blood sugar levels low. Serum calcium level may be high
  • Screening for steroid auto antibodies for autoimmune adrenalitis: They are positive in 50% cases with autoimmune Addison’s disease/crisis. Antibodies to 21-hydroxylase help confirm the diagnosis of autoimmune adrenal disease/crisis. Antibodies to thyroid may be present in 45% cases
  • CT scan of adrenal glands may reveal the underlying cause (hemorrhage, infiltration or masses)
  • Blood, sputum or urine culture may be positive of bacterial infection if it is the precipitating cause of the crisis.

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