If your primary doctor suspects adrenal insufficiency, you’ll need to see an endocrinologist to begin the diagnosis process.

Adrenal insufficiency is a condition of the adrenal glands. It happens when the glands don’t make enough of the hormones your body needs. Treatment can help manage symptoms.

Getting a diagnosis is the first step toward starting a treatment plan that works for you.

Read more about adrenal insufficiency.

If your primary care doctor suspects you have adrenal insufficiency, they will likely suggest that you see an endocrinologist.

Endocrinologists specialize in conditions that affect your hormones. They can diagnose adrenal insufficiency and manage your care.

An endocrinologist will begin by reviewing your symptoms and your medical history. In the early stages of adrenal insufficiency, symptoms often come and go and progress slowly. This can make diagnosis difficult.

Testing can help confirm the diagnosis and might include:

Morning serum cortisol test

This test checks the base cortisol level in your blood. Low cortisol is a sign of adrenal insufficiency.

Adrenocorticotropic hormone (ACTH) stimulation test

An ACTH stimulation test uses an intravenous or intramuscular injection of lab-made ACTH, a hormone your adrenal gland makes naturally, to see how your body responds.

People with typical adrenal function experience a rise in cortisol levels after the ACTH injection. People with adrenal insufficiency typically do not see a rise in cortisol levels.

Insulin tolerance test (ITT)

During this test, you’ll receive an IV injection of insulin and will then have your blood drawn every half an hour for the next 2 hours.

A healthy pituitary gland will make high levels of ACTH to respond to insulin, leading to high levels of cortisol, while low levels of cortisol can signal adrenal insufficiency.

You might have an ITT if your ACTH results don’t confirm your diagnosis or if your endocrinologist believes a problem in your pituitary gland is leading to secondary adrenal insufficiency.

Corticotropin-releasing hormone (CRH) stimulation test

You might have a CRH stimulation test if the results of other tests aren’t clear.

During this test, you’ll receive an IV injection of CRH and will then have blood drawn every half an hour for the next 2 hours. If your ACTH levels don’t rise, it can be a sign of adrenal insufficiency.

Adrenal insufficiency is broken down into three basic types:

  • Primary adrenal insufficiency: Also called Addison disease, this type occurs when there’s no underlying cause of the condition.
  • Secondary adrenal insufficiency: This type occurs as the result of another condition.
  • Tertiary adrenal insufficiency: This type occurs when something is affecting the production of CRH, leading to reduced pituitary function, which leads to reduced adrenal function.

Sometimes, bloodwork is enough to find the cause of adrenal insufficiency, but you might need additional testing after your diagnosis is confirmed. This can include imaging tests such as MRIs and CT scans.

These scans can help doctors get a close look at your adrenal gland, pituitary gland, and the brain region that controls CRH production so they can spot tumors and other growths that can sometimes cause adrenal insufficiency.

Diagnosing adrenal insufficiency often involves multiple tests, so it’s important to wait for a healthcare professional to interpret your results. There are also several variables to consider with each test, including differences in test types and laboratory practices.

Generally, a cortisol level that’s lower than the expected range may suggest adrenal insufficiency.

For ACTH simulation tests, which attempt to spike cortisol levels in your body, a cortisol level that doesn’t rise past a certain point may also suggest adrenal insufficiency.

What conditions mimic adrenal insufficiency?

The early symptoms of adrenal insufficiency are vague and can overlap with many other conditions. This can sometimes lead to misdiagnosis. It’s not uncommon for other conditions to be mistaken for, or to mimic, adrenal insufficiency.

Conditions that commonly mimic adrenal insufficiency include:

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Adrenal insufficiency can be managed with treatment. An endocrinologist can diagnose adrenal insufficiency and oversee treatment.

Tests to confirm a diagnosis include blood tests such as an ACTH stimulation test, an ITT test, and a CRH stimulation test.

Further testing, including MRI and CT imaging, is sometimes used to help find the underlying cause of adrenal insufficiency.