July 2006, Volume 36 Number 7 , p 24 - 25
WHITEMAN, KIM RN, CCRN, MSN
ADRENAL INSUFFICIENCY is a state of inadequate cortisol production caused by a problem in the hypothalamic-pituitary-adrenal axis. It can be primary, like Addison's disease (a problem with the adrenal glands themselves), or secondary (as when the anterior pituitary fails to release adrenocorticotropic hormone [ACTH] or the hypothalamus doesn't produce corticotropin-releasing hormone [CRH] to stimulate ACTH release from the pituitary). Healthy adrenal glands require ACTH stimulation to release cortisol into the blood. (See The process behind cortisol production .)
An ACTH stimulation blood test is ordered to evaluate whether the adrenal glands are producing sufficient amounts of cortisol. If your patient's adrenal glands are normal, administering synthetic ACTH should raise his serum cortisol level. But if the adrenal glands are dysfunctional, they won't respond to the administered ACTH, and his serum cortisol levels won't rise.