Suspected adrenal insufficency

Adrenal insufficiency is likely if the serum cortisol level is below 15 during critical condition or < 3 at 8:00 AM. Critically ill patients with established hypoadrenalism should be treated with hydrocortisone if no cintraindication. Ideally, a corticotropin test should be performed for diagnosis. If adrenal insufficiency is confirmed and ACTH levels are normal or high, further evaluation for mineralocorticoid deficiency should be performed (check PRA and aldosterone).