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The clinical features of adrenal insufficiency or excess are discussed in Chapters 534 and 535, respectively. The diagnostic evaluation of adrenal function is primarily dependent on laboratory measurements that determine the circulating levels of various steroids and hormones, often following perturbations of the system that help localize pathology. Clinical symptoms and signs generally lack sensitivity or specificity, and imaging studies are rarely helpful.

Measurement of Plasma Concentrations of Cortisol and Other Steroids

Measurement of the plasma concentrations of cortisol and other circulating steroids screens for adrenal disorders and may provide clues regarding specific enzymatic deficiencies. Tables 532-1 and 532-2 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 two or more samples for the measurement of any steroid.1-5

Table 532-1. Mean Sex Steroid Concentration in Infants and Children

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