Diagnosis – Adrenal Insufficiency

by Carlo Raj, MD

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    Let’s see diagnosis of adrenal insufficiency. Begin at the very top, we’ll go through kind of like what we did earlier with Cushing’s. Speaking of which, be careful when you go through this. I would highly recommend that you quickly, after our lecture here, go back and take a look at the algorithm for Cushing’s please because students always get these two algorithms confused because there might be a little bit of time delay before reviewing. It’s important that you have these firmly etched in your head, this is specific in algorithm for adrenal insufficiency; there is no dexamethasone suppression test, there’s no high dose/low dose and such. So, what are we looking at here? Diagnosis of adrenal insufficiency can’t… can be based on the following, excuse me, can be based on the following. Peak cortisol, obviously here it will be less. Technically speaking, now, clinically be careful, you might get a little bit of trouble because how often are you going to find a research committee that is… I’m just being practical here. How often can you find a research board or committee who will give you permission to then give your patient as much insulin as you would like? Do you know what I mean? Because if you give too much insulin, you might actually bring about a patient that has hypoglycemia coma. So, be careful. But, for exam purposes, if you give insulin, are you not creating stress? How? Because now, you’ve created a hypoglycemic fasting state. As soon as you’ve created a fasting state, what should you be releasing from the adrenals? There you go, cortisol. Gold standard perhaps called the insulin tolerance test, ITT. Do you understand that point now? If your patient has adrenal insufficiency, theoretically what you want to know here is you...

    About the Lecture

    The lecture Diagnosis – Adrenal Insufficiency by Carlo Raj, MD is from the course Adrenal Gland Disorders.

    Included Quiz Questions

    1. Insulin tolerance test
    2. Glucose tolerance test
    3. Dexamethasone suppression test
    4. 24 hours cortisol monitoring
    5. Diurnal ACTH levels
    1. Patients with hypothyroidism
    2. Hypoglycemic patients
    3. Patients with CAD
    4. Patients with a seizure disorder
    5. Patients over 60
    1. Random cortisol levels are less than 18 mcg/dL
    2. Positive ITT
    3. Positive Metyrapone test
    4. Peak cortisol less than 15 mcg/dL
    5. Morning cortisol reading less than 3 mcg/dL
    1. Metyrapone test
    2. Insulin tolerance test
    3. Glucose tolerance test
    4. Random ACTH
    5. Morning ACTH
    1. Primary AI requires mineralocoricoid replacement only
    2. Secondary AI requires glucocorticoid replacement only
    3. Lowest dose glucocorticoids should be used to relieve symptoms
    4. Stress-dose steroids should be given to ill patients
    5. Fludrocortisone commonly used for primary AI

    Author of lecture Diagnosis – Adrenal Insufficiency

     Carlo Raj, MD

    Carlo Raj, MD

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    wow wow wow Dr Raj the Magician
    By Hamed S. on 22. February 2017 for Diagnosis – Adrenal Insufficiency

    Amazing explanation of the diagnostic pathway for adrenal insufficiency. The talk was clear and concise! Thank you