Adrenal Insufficiency Panel- Basic

Discounted Labs offers a basic test for adrenal insufficiency. This test measures cortisol, ACTH, and DHEA levels. This is the first step in the process. After looking at these results, doctors might suggest an ACTH stimulation test. They may also check the levels of renin, potassium, and sodium. A CT scan of the adrenal glands can help find any growths. To look for Addison's Disease, which is a type of primary adrenal insufficiency, tests for 21-hydroxylase should also be done.

What is Adrenal Insufficiency and What are the Symptoms?

Adrenal insufficiency (AI) happens when the adrenal glands do not make enough steroid hormones. The main hormone that is low is cortisol. There may also be low amounts of aldosterone. Aldosterone is important for managing sodium and potassium levels in the body. It helps the body hold onto water, too. Many people with this condition feel a strong desire for salt or salty foods. This is because they lose sodium through urine.

Addison's disease and congenital adrenal hyperplasia are types of adrenal insufficiency. If this condition is not treated, it can lead to several health problems. These problems can include stomach pain, vomiting, muscle weakness, and feeling very tired. A person may feel down, have low blood pressure, lose weight, suffer from kidney failure, or notice changes in their mood. In severe cases, it can lead to shock, known as an adrenal crisis.

Adrenal insufficiency was really dangerous before 1949. In that year, cortisone was invented. This was a big step forward because it allowed us to replace glucocorticoids in treatment. Still, even with this major development, diagnosing and treating people with adrenal insufficiency remains tough.

Adrenal Insufficiency (AI) Caused by Medications

A study at the University of Bologna looked at more than 8,000 cases of AI. The aim was to find out the main reasons for drug-related AI and how this has changed over the last twenty years. The researchers discovered that 97.5% of the cases were serious. Furthermore, 41.1% of these cases needed hospital treatment.

The number of AI cases has gone up in recent years. A lot of these cases are about steroids. The use of these drugs has increased too. In 2015, cases of monoclonal antibodies made up 33%. Many of the cases included non-steroidal anti-inflammatory drugs. Researchers discovered that more than 70% of people used steroids alongside them.

What Lab Tests Are Used to Initiate Diagnosis of Adrenal Insufficiency?

Discounted Labs offers a simple adrenal insufficiency panel. This panel measures cortisol, ACTH, and dhea levels. These tests are only the beginning. Depending on the results, doctors may suggest more tests. These can include an ACTH stimulation test, a renin test, a potassium test, an aldosterone test, and a CT scan of the adrenal glands. To find Addison's disease, which is a type of primary adrenal insufficiency, labs will check for 21-hydroxylase autoantibodies.

Cortisol Blood Test

What is Cortisol?

Cortisol, also known as hydrocortisone, is an important type of glucocorticosteroid. It has several key roles in our body. Like other glucocorticosteroids, cortisol is made from cholesterol. This process takes place in a part of the adrenal gland called the zona fasciculata.

When cortisol enters the blood, about 90% attaches to proteins known as corticosteroid-binding globulin (CBG) and albumin. A tiny amount of cortisol remains free in the blood. This free cortisol can then bind to its receptors.

Functions of Cortisol

Cortisol has several important effects on the body. First, it raises blood sugar levels. This happens because cortisol helps create glucose and breaks down substances in the body. Additionally, cortisol can lower inflammation but may also weaken the immune system.

Production of Cortisol in the Body

The adrenal gland makes and releases cortisol. This happens through a system called the hypothalamus-pituitary-adrenal cortex-axis. When cortisol levels drop, the hypothalamus releases a hormone known as corticotropin-releasing hormone (CRH). This hormone tells the pituitary gland to release adrenocorticotropic hormone (ACTH). Then, ACTH prompts the adrenal gland to produce and release more cortisol. Cortisol also signals the pituitary gland and hypothalamus to lower cortisol production. When a person is under stress, their body produces more cortisol.

Cortisol Blood Levels During the Day

Serum cortisol levels change throughout the day. They reach their highest point in the morning. As the day goes on, cortisol levels decrease. By evening, they are about half of what they were in the morning. To correctly read the results, you need to know when the serum sample was collected.

What the Cortisol Test Can Help to Diagnose

The cortisol level in a patient helps doctors learn about the health of the adrenal gland, pituitary, and hypothalamus. High cortisol levels can show problems like Cushing syndrome. Low levels may suggest Addison disease. Checking these levels is important for treatment. Doctors might use dexamethasone suppression therapy for Cushing syndrome or hormone replacement therapy for Addison disease.

Factors that Affect Cortisol Blood Levels

Pregnancy, birth control, and estrogen therapy can increase cortisol levels. If patients take medications such as prednisolone, methylprednisolone, or prednisone, their cortisol levels might show higher numbers than what they actually are. Tests using metyrapone can show higher levels of 11-deoxycortisol. Occasionally, cortisol levels might appear high because of cross-reactions. Patients with 21-hydroxylase deficiency may have more 21-deoxycortisol. This can cause them to have higher cortisol levels.

It is important to consider the time when you take a sample. This can affect the results. Cortisol levels follow a daily pattern. When a person experiences strong stress, cortisol levels can increase too.

Samples from patients who got monoclonal mouse antibodies can give wrong results. This can happen in tests and diagnoses. Sometimes, if there are very high levels of antibodies to streptavidin and ruthenium, this may affect the test results. However, the test includes several extras to help reduce these issues.

The best way to find out if someone has Cushing syndrome is by checking cortisol in a 24-hour urine sample. This method is effective because the amount of cortisol in urine does not follow the usual daily pattern of release.

Potential Interference for the Cortisol Test

This test may have problems if the sample comes from someone who is using biotin supplements. Biotin is known as vitamin B7, B8, vitamin H, or coenzyme R. It is crucial to ask all patients if they take biotin supplements before the test. Patients need to stop using biotin at least 72 hours before they provide a sample.

ACTH Test

What is Adrenal Corticotropic Hormone (ACTH)?

Adrenocorticotropic hormone is produced in the front part of the pituitary gland in your brain.

The job of ACTH is to manage the levels of cortisol in the body. Cortisol is a stress hormone made by the adrenal glands. This hormone acts like an alarm system in our body. As the main stress hormone, cortisol supports different areas of the brain in handling fear, emotions, and motivation.

Cortisol is mainly known for helping the body handle stress. It starts the "fight-or-flight" response. However, cortisol is also key for several other functions in the body, such as:

• Keep a regular sleep and wake schedule.
• Boost your energy to manage stress and feel normal again.
• It affects how the body uses carbs, proteins, and fats.
• Reduce inflammation.
• Manage blood pressure.
• Increase blood sugar.

What Are the Symptoms of High or Low ACTH-Induced Cortisol?

High cortisol levels can lead to many issues. Some of these are high blood pressure, obesity, high blood sugar, and swelling. On the other hand, low cortisol levels may cause weight loss, tiredness, low blood pressure, and weak muscles.

What is the ACTH Test?

If you have signs of having too much or too little cortisol, your doctor may suggest an ACTH test. This test looks at the levels of ACTH and cortisol in your blood. The ACTH test helps your doctor see if there are any problems with your cortisol levels. Before giving you a definite answer, your doctor might also do a physical checkup.

DHEA Test

Dehydroepiandrosterone, known as DHEA, is a hormone made by the adrenal gland. The brain also makes some DHEA. This hormone plays a key role in creating androgens and estrogens, which are sex hormones for both men and women. Most of the DHEA in your body comes from the adrenal glands. Doctors can check for problems like adrenal cancer or hyperplasia by measuring DHEA-S in the blood. This checking also helps find some types of congenital adrenal hyperplasia.

People who have primary or central adrenal insufficiency often show low levels of serum DHEA-S. However, just having low DHEA-S does not mean that a person has this condition. If their serum DHEA-S level is normal for their age and sex, it almost confirms that they likely do not have adrenal insufficiency.

 

References

The Changing Face of Drug-induced Adrenal Insufficiency in the Food and Drug Administration Adverse Event Reporting System