This comprehensive guide is a compilation of medical information regarding the initial diagnosis of Adrenal Insufficiency (AI). Our goal is to promote better understanding of these procedures and encourage open dialogue between patients and physicians.
General Practitioners, (GP) and Nurse Practitioners, (NP) are typically the first medical provider patients consult. The complexities of the endocrine system offer unique challenges for medical providers regarding approach and test interpretation. Education of GP’s and NP’s regarding symptoms and initial testing procedures for AI may help reduce diagnostic times and the incidence of misdiagnosis.
The Hypothalamus-Pituitary-Adrenal (HPA) axis has a central role in regulating many homeostatic systems in the body, including the metabolic, cardiovascular, immune, reproductive, and central nervous systems. Although adrenal insufficiency is a result of insufficient cortisol production by the adrenal glands, the dysfunction may have a secondary (pituitary) or tertiary (hypothalamic) origin. In addition, disorders such as Chronic Fatigue Syndrome/Myalgic Encephalomyelitis (CFS/ME), recently renamed Systemic Exertion Intolerance Disease (SEID), and Fibromyalgia have their own diagnostic criteria with symptoms similar to adrenal insufficiency and care must be taken to distinguish between the illnesses to ensure the appropriate treatment is applied.
Although Addison’s Disease (AD) from autoimmune cause remains rare, the numbers of AI patients are rising driven by multiple factors, including the
- increase of associated endocrinopathies,
- suppression from exogenous steroid treatment for a primary condition, and
- prevalence of Endocrine Disrupting Chemicals (EDC’s) in our environment.
The current shortage of endocrinologists is expected to increase, and patient wait times for appointments can be lengthy. The average time from symptom onset to diagnosis is five years.
Diagnostic approach and testing for adrenal insufficiency in adults (PDF)