Methods for diagnosing adrenal gland disorders differ depending on the specific disorder. For example, the severe form of congenital adrenal hyperplasia (CAH) is most commonly identified during newborn screening, whereas paraganglioma is diagnosed using blood and urine tests.1
If a health care provider suspects Cushing’s syndrome, he or she may order one or more of the three screening tests currently in use for this disorder. One of the tests screens for elevated cortisol levels in saliva, whereas another test looks for elevated cortisol levels in the urine over 24 hours. A third test determines whether a synthetic steroid, called dexamethasone (pronounced dek-suh-METH-uh-sohn), suppresses cortisol production by the body.2
To diagnose Addison’s disease, a health care provider may administer a blood test to measure cortisol and adrenocorticotropic hormone (ACTH) levels. Then he or she may perform an ACTH stimulation test, an hour-long test during which a synthetic (man-made) form of ACTH (hormone produced by the pituitary gland) is administered through an intravenous (IV) line. The health care provider measures blood levels of various hormones before and after the ACTH is given and interprets these values to determine if adrenal insufficiency (lack of cortisol) is present.
The most common way that health care providers identify CAH in infants is through a newborn-screening blood test. If the first screening test indicates that the infant may have CAH, the health care provider will order another blood test to confirm the diagnosis. In some cases, female infants may have visible genital abnormalities that lead health care providers to suspect CAH as the cause. In these cases, health care providers will order an additional test to confirm the diagnosis.3,4 The milder form of CAH, when suspected, can also be diagnosed by the ACTH stimulation test.
The first step in diagnosing pituitary tumors is through a physical exam. This exam includes a neurologic examination and evaluation for signs of excessive hormone secretion. A health care provider may also conduct a vision test to determine whether the growth of a pituitary tumor has affected sight or peripheral vision. If results of this test lead the health care provider to suspect a pituitary tumor, he or she will order one or more tests of the patient’s endocrine function. To confirm the diagnosis, the health care provider may ask for a test of the patient’s visual field (the area visible at a given instant without moving the eyes) or a magnetic resonance imaging scan of the patient’s head.5,6
If a health care provider suspects a paraganglioma, he or she may administer a blood or urine test. The test measures the levels of catecholamines (pronounced kat-i-KOL-uh-meens), which are hormones that increase the heart rate, blood pressure, rate of breathing, and amount of energy available to the body, and metanephrines (pronounced met-uh-NEF-reens)—molecules into which catecholamines are broken down by the body.7,8
If a health care provider suspects hyperaldosteronism, he or she may order blood and urine tests to check for high levels of aldosterone and low levels of potassium. The health care provider also may order a computed tomography scan to determine whether a noncancerous tumor or other abnormal growth of the adrenal glands is present.9,10,11
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