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.

Diagnosis

• 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.