Ulta Lab Tests

Adrenal Insufficiency and Addison Disease

Adrenal insufficiency (AI) means the adrenal glands do not make enough cortisol. Addison’s disease is primary adrenal insufficiency, usually caused by autoimmune damage to the adrenal cortex; secondary/tertiary AI results from low ACTH from the pituitary/hypothalamus or from chronic glucocorticoid use. Because early symptoms can be vague—fatigue, dizziness, salt craving, low blood pressure—lab testing is essential.

A stepwise plan typically starts with an 8 a.m. (morning) serum cortisol and plasma ACTH, plus electrolytes. If results are borderline, clinicians use the cosyntropin (ACTH) stimulation test to confirm or exclude AI. In suspected primaryAI, plasma renin and aldosterone and 21-hydroxylase (adrenal) antibodies help define cause and mineralocorticoid status. These tests guide diagnosis and monitoring but do not replace medical evaluation—especially if symptoms are severe.

Signs, Symptoms & Related Situations

  • General: persistent fatigue, weakness, loss of appetite, weight loss, nausea

  • Circulatory: low blood pressure, dizziness on standing, salt craving

  • Skin: hyperpigmentation (palms, creases, scars) suggests primary AI

  • Metabolic: low sodium, high potassium, low blood sugar (especially in children)

  • Women’s health: irregular periods, low libido; hair loss in underarm/groin areas

  • Pituitary clues (secondary AI): headaches, vision changes, other low pituitary hormones

  • Urgent care—possible adrenal crisis: severe vomiting/diarrhea, abdominal pain, confusion, fainting, shock, or fever with hypotension. Seek emergency help immediately.

Why These Tests Matter

What testing can do

  • Screen with morning cortisol and ACTH to estimate adrenal reserve

  • Confirm with cosyntropin stimulation when results are borderline or unclear

  • Differentiate causes: high ACTH + low cortisol → primary AI; low/normal ACTH + low cortisol → secondary/tertiary AI

  • Assess mineralocorticoid status (renin/aldosterone) and autoimmune cause (21-hydroxylase antibodies)

  • Establish baselines for follow-up once you and your clinician set a plan

What testing cannot do

  • Diagnose from a single number without clinical context

  • Replace imaging or specialist dynamic tests (e.g., insulin tolerance) when indicated

  • Provide treatment advice—medication decisions belong with your clinician

What These Tests Measure (at a glance)

  • Morning Serum Cortisol (8 a.m.): first-line screen. Very low values suggest AI; clearly higher values make AI less likely. Assay cutoffs vary; interpret with your clinician. Oral estrogen can raise total cortisol (via CBG). Recent steroids can suppress results.

  • Plasma ACTH: high in primary AI; low or inappropriately normal in secondary/tertiary AI. Draw with morning cortisol.

  • Cosyntropin (ACTH) Stimulation Test (250 µg): measures cortisol rise at 30/60 minutes after synthetic ACTH. Blunted response supports AI. Thresholds differ by assay; follow your report’s reference notes.

  • Renin (PRA or direct) and Aldosterone: in primary AI, aldosterone is low and renin is high; in secondary/tertiary AI, these are often normal.

  • Electrolytes / CMP: hyponatremia and hyperkalemia suggest mineralocorticoid deficiency; glucose and kidney/liver markers provide context.

  • 21-Hydroxylase (Adrenal) Antibodies: positive in most autoimmune Addison’s disease; supports the cause.

  • DHEA-S: often low in AI; supportive, not diagnostic.

  • Thyroid & Other Autoimmune Screens (as indicated): TSH/free T4, B12, celiac markers—autoimmune diseases can cluster.

Quick Build Guide

Clinical question Start with Add if needed
Suspected primary AI (Addison’s) 8 a.m. Cortisol + ACTH + CMP/electrolytes Cosyntropin test • Renin + Aldosterone • 21-Hydroxylase Ab
Possible secondary/tertiary AI 8 a.m. Cortisol + ACTH Cosyntropin test • Pituitary hormone profile (clinician-directed)
Borderline morning cortisol Cosyntropin test Repeat morning cortisol ± DHEA-S
On or recently off glucocorticoids Coordinate timing with clinician Dynamic testing when safe; results may be suppressed
Electrolyte abnormalities CMP/electrolytes Renin + Aldosterone to assess mineralocorticoids

How the Testing Process Works

  1. Select the starting tests: morning cortisol and ACTH with electrolytes/CMP.

  2. Follow with confirmation: if results are unclear, your clinician may order a cosyntropin stimulation test.

  3. Define cause and extent: in primary AI, add renin/aldosterone and 21-hydroxylase antibodies; consider DHEA-S and related autoimmune screens.

  4. Prepare for accuracy: draw early morning; list all medications (including steroids, inhalers, creams, and biotinsupplements). Do not stop prescribed steroids without clinician guidance.

  5. Review & plan: results post to your secure account; discuss next steps and retesting with your clinician.

Interpreting Results (General Guidance)

  • Very low morning cortisol with high ACTH supports primary AI; low/normal ACTH suggests secondary/tertiary AI.

  • Cosyntropin test: an inadequate cortisol rise supports AI; clinicians use assay-specific cutoffs.

  • Electrolytes: low sodium/high potassium commonly indicate mineralocorticoid deficiency in primary AI.

  • Renin/aldosterone: high renin + low aldosterone favors primary AI.

  • Antibodies: 21-hydroxylase positive supports autoimmune Addison’s.
    Always interpret results with a qualified healthcare professional; use trends and the full clinical picture.

Choosing Panels vs. Individual Tests

  • Initial screen: 8 a.m. Cortisol + ACTH + CMP/electrolytes

  • Confirmation: Cosyntropin stimulation (250 µg) when cortisol is borderline or symptoms are significant

  • Primary AI work-up: Renin + Aldosterone + 21-Hydroxylase Ab

  • Secondary AI context: consider pituitary hormone profile per clinician

  • Monitoring: periodic electrolytes/CMP, with targeted hormones as directed

FAQs

Do I need to test in the morning?
Yes. Cortisol peaks around 8 a.m. Morning samples make results easier to interpret.

Can I test while using steroid pills, inhalers, or creams?
These can suppress the HPA axis and alter results. Do not stop any medicine on your own—ask your clinician how to time testing.

What’s the difference between primary and secondary AI?
Primary (Addison’s): adrenal problem—often autoimmune; ACTH is high. Secondary/tertiary: pituitary/hypothalamic problem or prior glucocorticoids; ACTH is low/normal.

Is a salivary cortisol useful here?
Salivary cortisol is helpful in Cushing’s screening, but it is not a first-line test for adrenal insufficiency.

Do I have to fast?
Fasting is usually not required for cortisol/ACTH, but follow any instructions on your order.

Can birth control or pregnancy affect results?
Oral estrogen and pregnancy raise cortisol-binding proteins, increasing total cortisol. Tell your clinician about hormones.

How often should I retest?
Timing is individualized. Many people repeat testing after changes in health or medications, guided by their clinician.

Related Categories & Key Tests

  • Hormone Tests Hub

  • Adrenal & Cortisol Tests • Cushing Syndrome Tests • Electrolytes & Hydration • Thyroid Testing • Autoimmune & Rheumatologic Tests

  • Key Tests: Morning Serum Cortisol • Plasma ACTH • Cosyntropin (ACTH) Stimulation Test • Plasma Renin Activity or Direct Renin • Aldosterone • 21-Hydroxylase (Adrenal) Antibodies • DHEA-S • Comprehensive Metabolic Panel (Electrolytes/Glucose)

References

  • Endocrine Society — Clinical practice guideline on diagnosis and management of primary adrenal insufficiency.
  • American Association of Clinical Endocrinology — Adrenal insufficiency diagnostic guidance.
  • NIH/NIDDK — Adrenal insufficiency and Addison’s disease overview.
  • Society guidance on ACTH stimulation testing and assay-specific cortisol cutoffs.
  • Reviews on autoimmune Addison’s disease and 21-hydroxylase antibodies.
  • Laboratory best practices for pre-analytical considerations in endocrine testing.

Available Tests & Panels

Your Adrenal Insufficiency and Addison Disease Tests menu is pre-populated in the Ulta Lab Tests system. Start with morning cortisol and ACTH plus electrolytes/CMP; add a cosyntropin stimulation test for confirmation, then renin/aldosterone and 21-hydroxylase antibodies if primary AI is likely. Follow any timing/collection guidance and review results with your clinician.

Understanding Adrenal Insufficiency and Addison Disease

Adrenal glands are small but play a big role in everyday life. They produce several hormones, most notably cortisol. Cortisol handles the "fight or flight" response and is how the body responds to stress.

Early Adrenal Disease Tests can track your hormone levels and determine if your hormones are out of balance. These tests are convenient and provide you with the health information you need.

Understanding the Adrenal Glands

The adrenal glands are located in the midsection of the body near the top of the kidneys. Each of the two parts of the glands—the medulla and the cortex—produces a different set of hormones.

These hormones include cortisol, aldosterone, DHEA and androgenic steroids, and epinephrine, and norepinephrine.

Adrenal Insufficiency and Addison Disease

When the adrenal glands are not working correctly, several health issues can arise. These can include adrenal insufficiency, congenital adrenal hyperplasia, Cushing Disease, Hyperaldosteronism, Pheochromocytoma, or Adrenal Cancer.

When the adrenal glands do not produce the necessary level of hormones, Adrenal Insufficiency, or Addison Disease, will occur. 

Unfortunately, once a person develops Addison's Disease, it will never go away, which is why it is imperative to be proactive with lab testing. If you catch issues before they get serious, there is a better chance of healing.

Signs and Symptoms of Adrenal Insufficiency and Addison Disease

The most common signs of Addison's Disease are:

  • Loss of appetite
  • Weight loss
  • Nausea and vomiting
  • Exhaustion
  • Pain around the adrenal glands
  • Skin darkening

This rare condition is onset by:

  • Autoimmune diseases
  • Infections
  • Cancer
  • Genetics

Lab Testing for Adrenal Insufficiency and Addison Disease

Several Addison Disease Tests are available through Ulta Labs. These tests cover a wide range of biomarkers and can help create a better understanding of where your health stands.

Adrenal Complete

Adrenal Complete is a panel with 8 tests that covers 41 biomarkers. This test will measure several factors, including a metabolic panel, cortisol levels, DHEA sulfate, iron levels, and magnesium. This test uses both saliva and blood specimen.

ULTA Adrenal Function Panel

The Adrenal Function Panel is a combination of 16 tests, which will review 77 biomarkers. This test takes both a saliva and blood specimen, and patients must fast for at least nine hours before.

The test will measure C-reactive protein, blood count, a metabolic panel, cortisol levels, DHEA sulfate, gamma-glutamyl transferase, hemoglobin, homocysteine, insulin levels, lactate dehydrogenase, lipid panel, magnesium levels, phosphate levels, vitamin D, D2, and D3, and uric acid.

STTM Adrenal Panel Total

The STTM Adrenal Panel Total test is a combination of 3 tests that will review 23 biomarkers. It covers aldosterone, a comprehensive metabolic panel (CMP), and magnesium levels.

The biomarkers reviewed in the CMP are albumin, the albumin/globulin ratio, alkaline phosphatase, alanine transaminase, aspartate aminotransferase, total bilirubin, the BUN and blood creatinine ratio, calcium levels, carbon dioxide levels, chloride levels, creatinine levels, glomerular filtration rate, globulin levels, insulin tolerance test, potassium levels, total protein levels, sodium levels, and blood urea nitrogen levels (BUN).

Benefits of Adrenal Insufficiency and Addison Disease Testing

Adrenal insufficiency tests are an important step to take control of your health and life. They are easy to complete and will provide you with a wealth of knowledge.

Better Understanding Your Body

Testing for adrenal insufficiency will cover a multitude of factors in your body. Understanding these levels and how they affect your body can help you make the necessary changes to get back on top of your health.

Catching Other Health Issues

Once you receive your test results, the levels you thought would be high could be right on track, but other levels may surprise you. This can open the door to other issues that could be affecting your health and the quality of your daily life.

Prevention of Addison's Disease

If you identify early that you are on a path towards Addison's disease, you can be proactive to get things under control. Perhaps a simple lifestyle change can improve levels and resolve any issues.

If you are genetically predisposed to Addison's Disease, tests can show you which biomarkers to monitor more closely and test more often.

Treatment

If the testing does result in a diagnosis of Addison's Disease, there are several treatment options available. Patients with Addison's Disease can treat the problem by taking hormones to make up for the ones that are not produced by the adrenal glands.

Lifestyle changes can dramatically alter the side effects of the disease, as well as stress, and blood pressure management.

If the disease goes untreated, an Addisonian crisis can happen. This causes low blood pressure, low blood sugar, and high levels of potassium in the blood. These issues may be life-threatening and need immediate treatment.

Feel More Confident About Your Health

Understanding what is going on internally and learning how lifestyle changes can impact that is an empowering feeling.

Having more confidence when it comes to making decisions regarding your health may require a little time upfront, but the information Ulta Lab Tests provide you with can make it very attainable.

Testing with Ulta Lab Tests

Ulta Lab Tests offers tests that are highly accurate and reliable so you can make informed decisions about your health. You can always guarantee secure and confidential results.

You do not need insurance or a doctor's referral to schedule your test. Ulta Lab Tests provides affordable pricing and 100% satisfaction guaranteed.

Order your Adrenal Insufficiency and Addison Disease Tests today. Results can be viewed online in 24 to 48 hours. Take charge of your health and track your progress with Ulta Lab Tests.