Understanding Lab Tests for Adrenal Insufficiency
Written by Private MD Labs Medical Writing Team • Last Updated: September 8, 2025
Adrenal insufficiency is a serious condition where the adrenal glands don't produce enough essential hormones, including cortisol, aldosterone, and other steroid hormones. This condition can be life-threatening if left untreated, making accurate diagnosis through blood testing crucial for proper management and treatment.
Top Recommended Test
Cortisol, AM
This is a primary diagnostic test that measures morning cortisol levels when they should be at their highest. Adrenal insufficiency is characterized by insufficient cortisol production, and a lower than normal morning cortisol value is a key indicator of this condition.
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Why Blood Testing is Essential for Diagnosis
Unlike conditions diagnosed through physical examination alone, adrenal insufficiency requires specific blood tests to measure hormone levels and identify the underlying cause. These tests can distinguish between primary adrenal insufficiency (Addison's disease) and secondary insufficiency caused by pituitary or hypothalamic disorders.
Other Core Diagnostic Tests for Adrenal Insufficiency
Cortisol, Total
This comprehensive cortisol measurement helps diagnose both primary adrenal insufficiency (Addison's disease) and secondary insufficiency due to pituitary or hypothalamic disorders. Deficient cortisol production leads to symptoms such as fatigue, muscle weakness, loss of appetite, and weight loss.
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Adrenal Antibody Screen with Reflex to Titer
This test identifies autoimmune causes of chronic adrenal insufficiency (Addison's disease) by detecting high levels of adrenal antibodies. A positive result indicates an autoimmune response against the adrenal glands, leading to deficiency in cortisol and aldosterone production.
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Aldosterone/Plasma Renin Activity Ratio, LC/MS/MS
This test measures aldosterone levels, a crucial hormone produced by the adrenal glands. In adrenal insufficiency, the adrenal glands don't produce adequate amounts of steroid hormones including aldosterone, leading to dangerously low levels that affect fluid and electrolyte balance.
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Additional Hormone Assessment Tests
Dehydroepiandrosterone (DHEA-s) Sulfate
Since DHEA-S is produced in the adrenal glands, low levels may indicate adrenal insufficiency. This test helps assess the overall function of the adrenal glands and their ability to produce adequate amounts of steroid hormones.
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DHEA (Dehydroepiandrosterone), Unconjugated, LC/MS/MS
This precise measurement of unconjugated DHEA helps confirm adrenal insufficiency, as the adrenal glands don't produce adequate amounts of steroid hormones including DHEA. Low levels are a strong indicator of compromised adrenal function.
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Pregnenolone, LC/MS
As a precursor to steroid hormones, pregnenolone levels can be low in adrenal insufficiency. This test helps assess the adrenal glands' ability to produce the foundational building blocks needed for hormone synthesis.
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Progesterone
The adrenal glands produce progesterone, and when they're not functioning properly due to adrenal insufficiency, progesterone levels may be low. This test provides additional insight into adrenal hormone production capacity.
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Supportive Tests for Comprehensive Assessment
Catecholamines, Fractionated, Plasma (Dopamine)
Adrenal insufficiency can cause decreased production of hormones like epinephrine. This test helps assess the adrenal medulla's function and can explain symptoms such as fatigue, body aches, unexplained weight loss, low blood pressure, and skin discoloration.
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Vitamin B5 (Pantothenic Acid)
Vitamin B5 is critical for adrenal hormone production, and deficiency can impact adrenal gland function. Testing this vitamin helps identify nutritional factors that may contribute to symptoms like fatigue, body aches, weight loss, and low blood pressure.
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Understanding Your Results
Adrenal insufficiency diagnosis typically requires multiple hormone tests to confirm the condition and determine its underlying cause. Your healthcare provider will interpret these results in the context of your symptoms and medical history to develop an appropriate treatment plan, which often includes hormone replacement therapy.
Important Considerations
The information provided here is for educational purposes only and is not a substitute for professional medical advice. Always consult with a healthcare provider for proper diagnosis and treatment of adrenal insufficiency, as this condition requires immediate medical attention and ongoing management.
