Adrenal Function

Endocrine markers complementing routine diagnostics of Adrenal Function

The fully automated Immunodiagnostic Systems panel for adrenal function include the plasma ACTH and Cortisol (serum and plasma) assays, as well as the unique Salivary Cortisol assay for use on the IDS-iSYS Multi-Discipline Automated System.

The adrenal cortex has three distinct zones which secrete various hormones under the direct control of specific feedback mechanisms 1. Cortisol secretion from the adrenal glands’ zona fasciculata is primarily regulated by corticotropin, also known as adrenocorticotropic hormone, or ACTH. ACTH is released from the anterior pituitary in response to hypothalamic neuropeptides and stress 1, 2 .

ACTH and cortisol measurements are frequently used in the assessment of adrenocortical function and other disturbances of the hypothalamic-pituitary-adrenal (HPA) axis.

These include the differential diagnosis of Cushing’s syndrome (CS), a large group of signs and symptoms due to prolonged and inappropriately high exposure to glucocorticoids, mainly cortisol 3. Many common signs of Cushing’s such as obesity, high blood pressure, and increased blood glucose are frequently observed today 4. In general, normal or high ACTH concentrations indicate pituitary or ectopic sources of ACTH, while low concentrations indicate an adrenal tumour secreting glucocorticoids 5. In addition to measurement of late night Salivary Cortisol levels, the Endocrine Society recommends the overnight dexamethasone suppression test as one of the screening tests for diagnosing CS 6, with a cut-off at <1.8 µg/dL cortisol as an indication of suppressed serum levels.

ACTH and cortisol levels also play a role in the diagnosis of Addison’s disease, a failure of the adrenal gland to produce cortisol. Patients with primary adrenal insufficiency (AI) can be diagnosed based on a combined measurement of early morning serum cortisol and plasma ACTH levels. The Endocrine Society recommends that a peak cortisol <18 µg/dL following a standard-dose corticotropin stimulation test is indicative of adrenal insufficiency 1, 6. Secondary AI most commonly requires dynamic testing such as the insulin tolerance test or the overnight metyrapone test 1, 7, 8.

  1. Charmandari, E., Nicolaides, N. C. & Chrousos, G. P. Adrenal insufficiency. Lancet 383, 2152-2167, (2014).
  2. Miller WL, Auchus RJ. The molecular biology, biochemistry, and physiology of human steroidogenesis and its disorders. Endocrine Reviews 32, 81–151, (2011)
  3. Lacroix, A., Feelders, R. A., Stratakis, C. A. & Nieman, L. K. Cushing’s syndrome. Lancet 386, 913-927, (2015)
  4. Findling, J. W. & Raff, H. Cushing’s Syndrome: important issues in diagnosis and management. The Journal of clinical endocrinology and metabolism 91, 3746-3753, (2006).
  5. Talbot, J. A., Kane, J. W. & White, A. Analytical and clinical aspects of adrenocorticotrophin determination. Annals of clinical biochemistry 40, 453-471, (2003).
  6. Nieman, L. K. et al. The diagnosis of Cushing’s syndrome: an Endocrine Society Clinical Practice Guideline. The Journal of clinical endocrinology and metabolism 93, 1526-1540, (2008).
  7. Bancos, I., Hahner, S., Tomlinson, J. & Arlt, W. Diagnosis and management of adrenal insufficiency. The Lancet. Diabetes & endocrinology 3, 216-226, (2015).
  8. Arlt, W. & Allolio, B. Adrenal insufficiency. Lancet 361, 1881-1893, (2003).

Adrenal Function

Portfolio Certification Clinical Area Product Type RUO/IVD

CE Marked
FDA Cleared

Automated IVD
Salivary Cortisol

CE Marked

Automated IVD

CE Marked

Automated IVD

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