How to confirm if a patient has adrenal insufficiency?

Hello doctor,

A patient suffers from the following symptoms;

1. Worsening fatigue, muscle weakness, malaise, for the past three months, though it was present to a smaller extent over several years.

2. Unintentional 30 lbs weight loss over one year.

3. Headaches over the past month.

4.Tremors, eye flashes, insomnia, irritable bowel syndrome, general poor appetite are present for at least one year.

5. Anxiety, depression.

6. Intermittent orthostatic hypotension and generalized hypotension have been present for the past six months.

7. Muscle twitches, mildly blurry vision are also presented since summer.

Alcohol abuse in recovery for 15 months. Unremarkable head MRI, head CT, regular basic CBC report, normal echo, normal ophthalmological exam. Cortisol of 11.4 mcg/dL and ACTH of 17 pg/mL in the morning.

Currently under

1. Trazodone 50 mg at bedtime.

2. Fluoxetine 30 mg once daily.

3. Vitamin D 5000 units daily.

4. Women's daily multivitamin (none of the above-mentioned medicines are prescribed for the current complaints)

Would you consider secondary or tertiary adrenal insufficiency a likely culprit, or would you recommend seeking a diagnosis elsewhere?

Kindly help.

Hi doctor,

Thank you for the reply.

Yes, it is somewhat expected that this will be a potential multiple diagnosis. Anxiety, depression, and IBS, to clarify, are long-standing issues. Muscle twitches etc. were only recently noted as being abnormal and it had been assumed to be a normal "human" experience. Thyroid values were normal. No history of other substance abuse. No prescription drug abuse or use of steroids of any kind.

Thank you.