Adrenocortical insufficiency is a condition where the adrenal glands fail to produce sufficient amounts of essential hormones. It is caused by damage to the adrenal cortex, resulting in deficient production of cortisol and aldosterone hormones. The Aldosterone/Plasma Renin Activity Ratio test is the most important test for diagnosing this condition.
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Adrenal insufficiency is caused by damage to the adrenal cortex, which prevents these small glands from producing adequate amounts of cortisol and aldosterone. The primary form, known as Addison's disease, occurs when the immune system mistakenly attacks and destroys the adrenal tissue. Secondary adrenal insufficiency happens when the pituitary gland fails to produce enough ACTH (adrenocorticotropic hormone), which normally signals the adrenals to make cortisol. Less common causes include tuberculosis, fungal infections, cancer spread to the adrenals, or abrupt withdrawal from long-term steroid medications.
The Aldosterone/Plasma Renin Activity Ratio test is the most important test for adrenal insufficiency because it measures both aldosterone hormone levels and plasma renin activity simultaneously. In people with adrenal insufficiency, aldosterone levels are typically low while renin activity becomes elevated, creating an abnormal ratio that confirms the adrenal glands are not producing enough hormones. This LC/MS/MS technology provides highly accurate measurements that help distinguish primary adrenal insufficiency (where the adrenals themselves are damaged) from secondary forms. Additional tests like morning cortisol levels and ACTH stimulation tests may be ordered to complete the diagnosis and determine the specific type of adrenal insufficiency.
You should get tested if you experience persistent fatigue that does not improve with rest, unexplained weight loss, low blood pressure that causes dizziness when standing, or darkening of your skin in unusual areas. Testing becomes urgent if you have been taking steroid medications for a long time and are planning to stop, or if you have symptoms that worsen during times of stress or illness. People with autoimmune conditions like type 1 diabetes or thyroid disease should also consider testing, as they have higher risk for developing adrenal insufficiency.
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What this means
Your aldosterone level is elevated above the optimal range, which may be contributing to high blood pressure and electrolyte imbalances. Elevated aldosterone causes your body to retain sodium and lose potassium, which can lead to symptoms like muscle weakness, fatigue, and persistent hypertension that's difficult to control with standard medications.
Recommended actions
Reduce sodium intake to less than 2,000 mg per day to help manage blood pressure
Increase potassium-rich foods like bananas, spinach, avocados, and sweet potatoes
Monitor blood pressure regularly at home and keep a log for your doctor
Follow up with an endocrinologist to discuss potential causes and treatment options
Consider retesting in 8-12 weeks after implementing dietary changes
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