The best diagnostic tool to confirm<unk>  is the ACTH stimulation test; however, if a patient is suspected to be suffering from an acute adrenal crisis, immediate treatment with IV corticosteroids is imperative and should not be delayed for any testing, as the patient's health can deteriorate rapidly and result in death without replacing the corticosteroids. Dexamethasone should be used as the corticosteroid if the plan is to do the ACTH stimulation test at a later time as it is the only corticosteroid that will not affect the test results. If not performed during crisis, then labs to be run should include: random cortisol, serum ACTH, aldosterone, renin, potassium and sodium. A CT of the adrenal glands can be used to check for structural abnormalities of the adrenal glands. An MRI of the pituitary can be used to check for structural abnormalities of the pituitary. However, in order to check the functionality of the Hypothalamic Pituitary Adrenal (HPA) Axis the entire axis must be tested by way of ACTH stimulation test, CRH stimulation test and perhaps an Insulin Tolerance Test (ITT). In order to check for Addison's Disease, the auto-immune type of primary<unk> , labs should be drawn to check 21-hydroxylase autoantibodies. Effects Source of pathology CRH ACTH DHEA DHEA-S cortisol aldosterone renin Na K Causes5 hypothalamus(tertiary)1 low low low low low3 low low low low tumor of the hypothalamus (adenoma), antibodies, environment (i.e. toxins), head injury pituitary(secondary) high2 low low low low3 normal low low normal tumor of the pituitary (adenoma), antibodies, environment, head injury,surgical removal6, Sheehan's syndrome adrenal glands(primary)7 high high high high low4 low high low high tumor of the adrenal (adenoma), stress, antibodies, environment, Addison's disease, trauma, surgical removal (resection), miliary tuberculosis of the adrenal 1 Automatically includes diagnosis of secondary (hypopituitarism) 2 Only if CRH production in the hypothalamus is intact 3 Value doubles or more in stimulation 4 Value less than doubles in stimulation 5 Most common, does not include all possible causes 6 Usually because of very large tumor (macroadenoma) 7 Includes Addison's disease
Adrenal insufficiency
Postural orthostatic tachycardia syndrome  Postural orthostatic tachycardia syndrome  1
Adrenal fatigue
Precocious puberty
Hypogonadism
Adrenalitis
Thyroid storm
Organomegaly