[Adrenal insufficiency--diagnosis and treatment in clinical practice]

Adaequate stimulation of the hypothalamic-pituitary-adrenal axis (cortisol-axis) is essential for the adaptation of the human organism to stress and the preservation of homeostasis. Clinical and laboratory changes in adrenal insufficiency are often non-specific, therefore stimulation tests are needed in the assessment of the cortisol-axis. The most common cause of primary adrenal insufficiency is autoimmune adrenalitis (as part of the polyglandular autoimmune syndrome), while treatment with glucocorticoids is responsible for secondary adrenal insufficiency. Chronic adrenal insufficiency is reliably diagnosed by conventional or low-dose ACTH test. However, in the acute stage or in critically ill patients, cortisol deficiency is diagnosed on clinical grounds, namely hemodynamic instability and catecholamine resistance along with the results of the ACTH test. The dose of glucocorticoid replacement depends on body surface and has to be adjusted in stressful events.