Adrenal hypofunction exists on a continuum, from mildly under productive glands (also termed adrenal fatigue) to the severely under productive glands of Addison's disease to the life-threatening condition of adrenal crisis. Effective methods of diagnosing adrenal insufficiency vary, based on the severity of the problem and symptoms. It is worth noting that some tests may accurately detect a severe adrenal problem but completely miss mildly under functioning glands.
Blood and Urine Tests
An individual with symptoms of adrenal insufficiency may have his cortisol level checked either in blood or in urine, which reflects blood cortisol concentration. If levels are abnormal, an ACTH stimulation test is often the next step in the process of diagnosis.
The pituitary gland normally secretes ACTH, the hormone that stimulates the adrenal glands to produce cortisol. To test severe adrenal hypofunction, an ACTH-like drug is administered, and blood cortisol levels are checked at regular intervals. Normal results vary, depending on which specific test is used. Abnormal results provide insight into cause of low cortisol production and allow a doctor to determine whether the adrenal glands or the pituitary are the source of the problem.
Saliva Tests
Testing serum or urinary cortisol may be useful in cases of severe adrenal insufficiency, but these laboratory tests are of limited use in picking up adrenal fatigue. For someone with mild to moderate adrenal hypofunction, a far better test is the Adrenal Stress Index, a saliva test that measures cortisol levels several times per day and plots the results on a curve. Saliva hormone levels represent biologically-active hormone levels, unlike serum cortisol, and are much more useful for detecting adrenal fatigue. The curve that the salivary cortisol readings yields is then charted against a normal cortisol curve and the comparison provides information about the nature and severity of adrenal insufficiency.
Home Tests
While not officially methods of diagnosis, home tests for adrenal fatigue may provide useful information about adrenal status, both for establishing a baseline as well as tracking recovery. The first home test is based on the fact that blood pressure is related to adrenal function, and those with adrenal insufficiency often experience orthostatic hypotension (a sudden drop in blood pressure when rising from a seated or lying position). This test requires a blood pressure gauge, and simply involves measuring blood pressure after lying down for 10 minutes, and then standing up and measuring blood pressure again. If the blood pressure reading drops 10 mmHg or more upon rising, adrenal insufficiency is likely.
Finally, several questionnaires are available online that can give some indication of the presence and/or severity of adrenal fatigue. A questionnaire can be a first step in assessing adrenal status and determining whether further testing is necessary (see Resources).
References
- "Mosby's Manual of Diagnostic and Laboratory Tests"; Kathleen Pagana, PhD, RN and Timothy Pagana, MD, FACS; 2002.
- "Adrenal Fatigue, The 21st Century Stress Syndrome"; James Wilson, ND, DC, PhD; 2001.
- "Slim, Sane, & Sexy: Pocket Guide to Natural, Bioidentical Hormone Balancing"; Jay Mead, MD and Erin Lommen, ND; 2008.
