Adrenal Insufficiency
What Is It?
Inadequate cortisol (and sometimes aldosterone) production. Primary (Addison disease) is adrenal gland failure. Secondary is due to pituitary dysfunction or long-term steroid use. Can be life-threatening in adrenal crisis.
How Is It Diagnosed?
8 AM cortisol (low: <3 mcg/dL suspicious, >18 mcg/dL rules out). ACTH stimulation test (gold standard). ACTH level distinguishes primary vs. secondary.
How Is It Treated?
Hydrocortisone (15-25 mg/day in divided doses) for cortisol replacement. Fludrocortisone for primary adrenal insufficiency (aldosterone deficiency). Stress dosing during illness, surgery, or trauma. Medical alert bracelet.
Tests and Imaging Typically Needed
Morning cortisol, ACTH stimulation test, ACTH level, DHEAS, aldosterone, renin, BMP (hyponatremia, hyperkalemia in primary), CBC.
Approximate Self-Pay Costs
Office visit: $95-$150. ACTH stim test: $200-$400. Hydrocortisone: $20-$50/month. Endocrinology referral required.