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INTRODUCTION

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The diagnostic evaluation of adrenal function depends largely on chemical measurements of circulating steroid levels or excretion of their urinary metabolites. Stimulation tests can help localize pathology. Clinical symptoms and signs generally lack sensitivity or specificity, and imaging studies are rarely helpful.

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PLASMA STEROIDS

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The plasma concentrations of cortisol and other steroids can screen for adrenal disorders and provide clues regarding specific enzymatic deficiencies. Tables 525-1 and 525-2 summarize the normal plasma concentrations for a variety of steroids. With the notable exception of dehydroepiandrosterone sulfate (DHEAS), most adrenal steroids exhibit a diurnal variation based on the diurnal rhythm of corticotropin (ACTH). Because the stress of illness or hospitalization can increase adrenal steroid secretion and because diurnal rhythms may not be well established prior to 3 years of age, it is best to obtain 2 or more samples for the measurement of any steroid.

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TABLE 525-1MEAN SEX STEROID CONCENTRATION IN INFANTS AND CHILDREN
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Table Graphic Jump Location
TABLE 525-2MEAN GLUCOCORTICOID AND MINERALOCORTICOID CONCENTRATIONS

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