What doctor diagnoses adrenal insufficiency?

October 2, 2025 •

4 min read

Adrenal insufficiency, a rare but serious endocrine disorder, can be tricky to diagnose due to its nonspecific symptoms. An accurate diagnosis, however, is critical for effective management and preventing a life-threatening adrenal crisis. Understanding what doctor diagnoses adrenal insufficiency is the first step toward getting proper care.

Quick Summary

An endocrinologist, a specialist in hormone disorders, is the primary physician responsible for diagnosing adrenal insufficiency after an initial screening by a primary care provider. This process involves a detailed review of symptoms, medical history, specialized blood tests like the ACTH stimulation test, and possibly imaging studies to determine the underlying cause.

Key Points

Endocrinologist Specialization: For a definitive diagnosis of adrenal insufficiency, you will be referred to an endocrinologist, a specialist in hormonal disorders.
Initial Screening by PCP: Your primary care provider will first screen for the condition based on your symptoms and basic lab tests, then refer you to a specialist.
Key Diagnostic Test: The adrenocorticotropic hormone (ACTH) stimulation test is the primary tool used by endocrinologists to confirm the diagnosis.
Differentiating Types: Specialized testing helps distinguish between primary (Addison's disease, involving the adrenals) and secondary (involving the pituitary) adrenal insufficiency.
Lifelong Management: Once diagnosed, an endocrinologist will manage lifelong hormone replacement therapy and educate you on handling stress doses and emergencies like adrenal crisis.
Preventing Complications: Early and accurate diagnosis under a specialist's care is crucial for preventing life-threatening complications such as an adrenal crisis.

The Role of the Primary Care Provider

Your journey toward an adrenal insufficiency diagnosis typically begins with your primary care provider (PCP). These doctors are often the first to recognize a pattern of fatigue, unexplained weight loss, and other subtle symptoms that might suggest an underlying hormonal issue. While a PCP can order initial blood work to check cortisol levels, they will almost always refer you to a specialist for confirmatory testing and long-term management.

Initial Evaluation by Your PCP

Before referring you to a specialist, your primary care doctor will perform a thorough evaluation, which may include:

Reviewing your medical history: This includes any history of autoimmune diseases, prolonged steroid use, or previous surgeries involving the adrenal or pituitary glands.
Discussing symptoms: They will ask about your symptoms, which can include fatigue, dizziness, skin darkening, and salt cravings.
Basic blood tests: A blood test to check morning cortisol and certain electrolyte levels (sodium and potassium) can provide a preliminary indicator of adrenal dysfunction.

The Role of the Endocrinologist

If your PCP suspects adrenal insufficiency, the next step is a referral to an endocrinologist. As experts in the endocrine system, these physicians specialize in conditions affecting the adrenal glands, pituitary gland, and other hormone-producing organs. Their expertise is essential for both an accurate diagnosis and creating a long-term management plan.

How an Endocrinologist Diagnoses Adrenal Insufficiency

The diagnostic process for adrenal insufficiency requires specialized testing that an endocrinologist is equipped to perform and interpret. The primary diagnostic tool is the ACTH (adrenocorticotropic hormone) stimulation test.

The ACTH Stimulation Test

This test measures how your adrenal glands respond to a synthetic version of ACTH. Here's how it works:

Initial blood draw: A blood sample is taken to measure your baseline cortisol level.
ACTH injection: You receive an injection of synthetic ACTH.
Subsequent blood draws: Your blood is drawn again 30 and/or 60 minutes after the injection to see if your cortisol level rises.

In a healthy person, the adrenal glands will produce more cortisol in response to the ACTH. In a person with adrenal insufficiency, the cortisol response is blunted or absent. The results of this test help the endocrinologist differentiate between primary and secondary adrenal insufficiency.

Differentiating Between Primary and Secondary Insufficiency

An endocrinologist uses several methods to determine the specific cause of the condition:

Primary (Addison's Disease): If the ACTH level is high (because the pituitary is trying to stimulate non-responsive adrenal glands) but cortisol is low, this points to a problem with the adrenal glands themselves. Further testing may look for autoimmune antibodies.
Secondary/Tertiary: If both ACTH and cortisol levels are low, this indicates a problem originating in the pituitary or hypothalamus, not the adrenal glands. This might require an insulin tolerance test or a CRH stimulation test.

Imaging and Additional Tests

To identify the root cause, an endocrinologist may also order advanced imaging or lab work:

CT scan: A CT scan of the abdomen can reveal changes to the size or structure of the adrenal glands, which might indicate infection, bleeding, or cancer.
MRI: An MRI of the brain can assess the pituitary and hypothalamus for tumors or other issues that could cause secondary or tertiary adrenal insufficiency.
Antibody testing: A blood test for 21-hydroxylase antibodies can confirm if the adrenal insufficiency is autoimmune in nature (Addison's disease).

Long-Term Management and Team Care

Once an endocrinologist confirms the diagnosis, they will oversee the long-term management of your condition. This typically involves lifelong hormone replacement therapy.

The Importance of Team-Based Care

Managing adrenal insufficiency is a team effort. While the endocrinologist leads the treatment, other specialists may be involved depending on the underlying cause. For example, if a pituitary tumor is the cause, a neurosurgeon may be consulted. The entire team works together to ensure you receive comprehensive care.

Living with Adrenal Insufficiency

Proper management allows most individuals with adrenal insufficiency to live normal, active lives. This includes carrying a medical alert card, knowing how to adjust medication during times of stress, and having an emergency injection kit readily available. Patient education is a cornerstone of effective management, and organizations like the National Institute of Diabetes and Digestive and Kidney Diseases (NIDDK) offer valuable resources for those with the condition.

Comparison of Adrenal Insufficiency Types


Feature	Primary Adrenal Insufficiency (Addison's Disease)	Secondary Adrenal Insufficiency
Cause	Damage to the adrenal glands, most often autoimmune.	Lack of ACTH from the pituitary gland.
Cortisol Levels	Low.	Low.
ACTH Levels	High.	Low or normal.
Aldosterone Levels	Low.	Normal.
Symptoms	Fatigue, weakness, skin hyperpigmentation, salt cravings.	Fatigue, weakness, hypoglycemia; rarely hyperpigmentation or salt cravings.

Conclusion

While your primary care doctor may be the first to identify potential signs, it is an endocrinologist who has the specialized knowledge and testing required to confirm the diagnosis of adrenal insufficiency. By coordinating with this specialist, patients can embark on a successful lifelong management plan. Early and accurate diagnosis is essential for avoiding serious complications and living a full, healthy life.

Frequently Asked Questions

The first step is to schedule an appointment with your primary care provider. Explain all of your symptoms, such as fatigue, weight loss, or dizziness. They can perform an initial evaluation and will refer you to an endocrinologist if necessary.

A primary care doctor can suspect adrenal insufficiency based on your symptoms and initial blood tests, but they will not make the final diagnosis. The standard diagnostic tests, like the ACTH stimulation test, require the expertise of an endocrinologist.

An endocrinologist is a doctor who specializes in treating disorders of the endocrine system, which includes hormone-producing glands such as the adrenal glands, thyroid, and pituitary gland.

The diagnostic timeline can vary. Because symptoms often start slowly and are nonspecific, it can take time to connect them to adrenal insufficiency. The specialized tests performed by an endocrinologist can provide a definitive diagnosis, but finding the underlying cause may require additional imaging or lab work.

The endocrinologist will perform an ACTH stimulation test, where blood cortisol levels are measured before and after an injection of synthetic ACTH. Other tests may include blood tests for electrolytes, hormone levels, and specific antibodies.

Addison's disease is a type of adrenal insufficiency, specifically primary adrenal insufficiency, where the adrenal glands themselves are damaged, most often by an autoimmune response. Secondary and tertiary adrenal insufficiency are caused by problems with the pituitary or hypothalamus, respectively.

If left untreated, adrenal insufficiency can lead to an adrenal crisis, a life-threatening emergency. An adrenal crisis is characterized by very low blood pressure, shock, and can be fatal if not treated immediately with injectable steroids and IV fluids.