Chronic adrenal insufficiency (suspected, stopping long-term corticosteroids)
BioMG follows French guidelines. Adapt it to the guidelines and the tests available where you practise.
Suspected primary adrenal insufficiency
Fasting laboratory tests at 8 am
- 8 am serum cortisol (sample between 8 am and 9 am)
- Plasma ACTH on the same sample (EDTA tube, refrigerated centrifugation, freezing within the hour)
- Serum electrolytes
- Fasting plasma glucose
- No hydrocortisone since noon the day before; no oral oestrogen (see the note).
Suspected corticotropic insufficiency (outside corticosteroid treatment)
Fasting laboratory tests at 8 am
- 8 am serum cortisol (sample between 8 am and 9 am)
- Plasma ACTH on the same sample (EDTA tube, refrigerated centrifugation, freezing within the hour)
- Serum electrolytes
- Fasting plasma glucose
Stopping long-term corticosteroids
Laboratory tests at 8 am
- 8 am serum cortisol (sample between 8 am and 9 am)
- Last dose of prednisone or prednisolone the morning of the day before (24 hours earlier), of hydrocortisone at noon the day before; resume treatment just after the sample.
Known primary adrenal insufficiency: annual monitoring
Annual fasting laboratory tests
- Serum electrolytes (sodium, potassium)
- TSH
- Fasting plasma glucose
- FBC
- Vitamin B12
- Renin (if signs of fludrocortisone under- or overdosing)if neededTo adjust fludrocortisone: renin is kept in the upper range or slightly above normal; a raised renin suggests underdosing, a low or undetectable renin overdosing [10].
- Lipid profile (in adults, if high hydrocortisone dose or signs of overdosing)if needednon-French guidelineNICE (2024) proposes a lipid profile for every adult followed for adrenal insufficiency, to guide treatment [2]. The SFE does not include it in the follow-up tests and guides the search for cardiovascular complications by the clinical picture, while noting an unfavourable lipid profile above 20 mg/day hydrocortisone equivalent [10].
Do not order
Sources (13)
- Chabre O, Goichot B, Zenaty D, Bertherat J. Group 1. Epidemiology of primary and secondary adrenal insufficiency: Prevalence and incidence, acute adrenal insufficiency, long-term morbidity and mortality. Ann Endocrinol (Paris). 2017;78(6):490-494. Version française : Consensus de la SFE sur l'insuffisance surrénale primaire. Épidémiologie de l'insuffisance surrénale. MCED, 2018 (hébergée par la SFE).
- National Institute for Health and Care Excellence (NICE). Adrenal insufficiency: identification and management. NICE guideline NG243, publiée le 28 août 2024.
- Chanson P, Guignat L, Goichot B, Chabre O, Samara Boustani D, Reynaud R, et al. Group 2: Adrenal insufficiency: screening methods and confirmation of diagnosis. Consensus SFE/SFEDP sur l'insuffisance surrénale. Ann Endocrinol (Paris). 2017;78(6):495-511.
- Médicalement Geek. Dragi Webdo n°452 : insuffisance surrénale (NICE). Septembre 2024 (résumé en français de la recommandation NICE NG243).
- Société française d'endocrinologie (Chabre O, Bertherat J, Borson-Chazot F, et al.). Diagnostiquer l'insuffisance surrénale sans Synacthène® : utilisation du dosage du cortisol sérique à 8 h/8 h 30 du matin. Recommandations transitoires, août 2013.
- Bornstein SR, Allolio B, Arlt W, Barthel A, Don-Wauchope A, Hammer GD, et al. Diagnosis and Treatment of Primary Adrenal Insufficiency: An Endocrine Society Clinical Practice Guideline. J Clin Endocrinol Metab. 2016;101(2):364-89.
- Laboratoire Cerba. Fiche d'examen « ACTH » (conditions de prélèvement), consultée le 11 octobre 2026.
- Beuschlein F, Else T, Bancos I, Hahner S, Hamidi O, van Hulsteijn L, et al. European Society of Endocrinology and Endocrine Society Joint Clinical Guideline: Diagnosis and Therapy of Glucocorticoid-induced Adrenal Insufficiency. J Clin Endocrinol Metab. 2024;109(7):1657-1683 (publication simultanée : Eur J Endocrinol. 2024;190(5):G25-G51).
- Reznik Y, Barat P, Bertherat J, Bouvattier C, Castinetti F, Chabre O, et al. SFE/SFEDP adrenal insufficiency French consensus: Introduction and handbook. Ann Endocrinol (Paris). 2018;79(1):1-22.
- Guignat L, Proust-Lemoine E, Reznik Y, Zenaty D. Group 6. Modalities and frequency of monitoring of patients with adrenal insufficiency. Patient education. Ann Endocrinol (Paris). 2017;78(6):544-58. Version française : Consensus de la SFE sur l'insuffisance surrénale primaire. Modalités et rythme de surveillance au long cours chez le patient avec insuffisance surrénale. Éducation thérapeutique du patient. MCED n° 93, avril 2018.
- Michels A, Michels N. Addison Disease: Early Detection and Treatment Principles. Am Fam Physician. 2014;89(7):563-568.
- Yanase T, Tajima T, Katabami T, et al. Diagnosis and treatment of adrenal insufficiency including adrenal crisis: a Japan Endocrine Society clinical practice guideline. Endocr J. 2016;63(9):765-784.
- Husebye ES, Allolio B, Arlt W, et al. Consensus statement on the diagnosis, treatment and follow-up of patients with primary adrenal insufficiency. J Intern Med. 2014;275(2):104-115.