The diagnosis and investigation of adrenal insufficiency in adults

This version was published on 1 September 2009

Ann Clin Biochem 2009;46:351-367
© 2009 Association for Clinical Biochemistry


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Review Article

Ian Wallace1,
Sean Cunningham2 and
John Lindsay1

1 Altnagelvin Area Hospital, Western Health & Social Care Trust, Glenshane Road, Londonderry BT47 6SB, UK;
2 St Vincent’s University Hospital, Dublin, Ireland

Corresponding author: Dr John Lindsay, Consultant Physician, Endocrinology & Diabetes, Altnagelvin Area Hospital, Glenshane Road, Londonderry BT47 6SB, UK. Email: john.lindsay{at}

There is considerable variation in the methods used to diagnoseand investigate adrenal insufficiency in clinical practice.These include a range of adrenocorticotropin (ACTH) stimulationand other dynamic testing protocols, serum cortisol cut-offvalues for diagnosis and tests used for differential diagnosis.With the introduction of modern cortisol and ACTH assays, theinterpretation of tests used for diagnosis and differentialdiagnosis has become more complex and requires local validation.This review examines the basis of normal hypothalamic–pituitary–adrenalaxis function and adrenal insufficiency states based upon anevidence base accumulated over the past four decades. The roleof the laboratory in the differential diagnosis and interpretationbased upon assay methodology is discussed. The accurate identificationof patients who may benefit from corticosteroid replacementin special settings such as critical illness is challengingand will be explored.

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A. A A Ismail
On the diagnosis and investigation of adrenal insufficiency in adults
Ann Clin Biochem,

January 1, 2010;


97 – 98.

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