Urgent Investigation in Suspected Acute Adrenal Insufficiency

Urgent Investigation in Suspected Acute Adrenal Insufficiency

Creatinine, sodium and potassium, glucose^*
Venous blood gases and lactate
Plasma cortisol ^‡
Plasma corticotrophin (ACTH) (taken in EDTA tube, for later analysis; transport immediately to the laboratory for freezing)
Thyroid function tests
Full blood count
Coagulation screen
C-reactive protein
Blood culture
Urine microscopy and culture
Chest X-ray
ECG

^* Typical biochemical findings in acute adrenal insufficiency are raised creatinine, low sodium (120–130 mmol/L), raised potassium (5–7 mmol/L), low glucose.

^‡ The cortisol level at presentation may be difficult to interpret. In a critically ill patient, a level of <500nmol/L is suspicious for insufficiency.

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Table 90.3