Diagnostic strategies in adrenal insufficiency. Issue 3 (7th June 2023)

• Record Type: Journal Article
• Authors: Siampanopoulou, Vasiliki; Tasouli, Elisavet; Angelousi, Anna
• Is Part Of: Current opinion in endocrinology, diabetes and obesity. Volume 30:Issue 3(2023)
• Page Start: 141
• Page End: 153
• Publication Date: 2023-06-07
• Subjects: Addison disease -- adrenal insufficiency -- diagnosis -- diagnostic tests; Endocrinology -- Periodicals; Diabetes -- Periodicals; Obesity -- Periodicals; Diabetes Mellitus -- Periodicals; Endocrine System Diseases -- Periodicals; Endocrine Glands -- Periodicals; Obesity -- Periodicals; Endocrinologie -- Périodiques; Diabète -- Périodiques; Obésité -- Périodiques; Diabetes; Endocrinology; Obesity; Periodicals; 616.4
• DOI: 10.1097/MED.0000000000000806
• Languages: English
• ISSNs: 1752-296X

Abstract

Abstract : Purpose of review: Adrenal insufficiency (AI) is the clinical manifestation of deficient production of glucocorticoids with occasionally deficiency also in mineralocorticoids and adrenal androgens and constitutes a fatal disorder if left untreated. The aim of this review is to summarize the new trends in diagnostic methods used for determining the presence of AI. Recent findings: Novel aetiologies of AI have emerged; severe acute respiratory syndrome coronavirus 2 infection was linked to increased frequency of primary AI (PAI). A new class of drugs, the immune checkpoint inhibitors (ICIs) widely used for the treatment of several malignancies, has been implicated mostly with secondary AI, but also with PAI. Salivary cortisol is considered a noninvasive and patient-friendly tool and has shown promising results in diagnosing AI, although the normal cut-off values remain an issue of debate depending on the technique used. Liquid chromatography–mass spectrometry (LC–MS/MS) is the most reliable technique although not widely available. Summary: Our research has shown that little progress has been made regarding our knowledge on AI. Coronavirus disease 2019 and ICIs use constitute new evidence on the pathogenesis of AI. The short synacthen test (SST) remains the 'gold-standard' method for confirmation of AI diagnosis, although salivary cortisol is a promising tool.