Central Hypothyroidism::: there will be low TSH and low T4... also there will be other imbalances as the pituitary secretes many hormones... there will be hyponatremia, low morning cortisol, and low blood glucose... an ACTH stimulation test would be the next step in the work-up... Levothyroxine treatment in patients will central hypothyroidism at the pituitary can cause adrenal crisis
Metyrapone stimulation test. Whether the pituitary is to blame when a patient is deficient in cortisol (Addison's disease). Decreased cortisol production leads to increased ACTH production by the pituitary, which should end up with normal cortisol. People who can't overcome this block have impaired pituitary function.
Steroid Tapering::: usually only required for those who have been taking steroids for over 3 weeks... if used for under 3 weeks, steroids can be stopped abruptly... if the physician is unsure of stopping the steroid and whether there will be HPA axis suppression, they can do an ACTH stimulation test... patients who do not have increased cortisol production in response to ACTH will require a taper
Algorithm for the diagnosis of adrenal insufficiency (AI). The standard cosyntropin stimulation test (CST) may be used as the first-line test for evaluation of adrenal function. The CST may be unreliable in patients with new-onset (<2-4 weeks) secondary or tertiary AI. ACTH, adrenocorticotropic hormone