What Specialist Treats Adrenal Insufficiency
An endocrinologist is the specialist who diagnoses and manages adrenal insufficiency. This is explicitly stated in multiple clinical guidelines, which consistently recommend endocrinology consultation for patients with suspected or confirmed adrenal insufficiency 1.
When to Involve Endocrinology
Best practice is to collaborate with the patient's endocrinologist when planning scheduled surgery and when caring for postoperative patients with adrenal insufficiency 1. The guidelines emphasize that endocrinology consultation should occur at admission for patients with known adrenal insufficiency requiring hospitalization 1.
Mandatory Endocrine Consultation Scenarios
The following situations require endocrinology involvement 2:
- Newly diagnosed adrenal insufficiency - to establish appropriate replacement therapy and patient education
- Pre-operative planning - to determine stress-dose steroid protocols
- Recovery protocols after prolonged steroid use - to guide HPA axis recovery assessment
- Recurrent adrenal crises - to optimize management and prevent future episodes
- Patients with adrenal insufficiency developing fluid-resistant hypotension - stress-dose steroids should be administered in consultation with an endocrinologist per institutional standards 1
Role of Other Specialists
While endocrinologists are the primary specialists, other physicians play important roles in specific contexts:
- Emergency physicians and intensivists manage acute adrenal crisis, though endocrinology consultation should follow once the patient is stabilized 1
- Anesthesiologists collaborate with endocrinologists for perioperative glucocorticoid management 1
- Primary care physicians may initiate the diagnostic workup but should refer to endocrinology for confirmation and long-term management 3, 4
Why Endocrinology Expertise Matters
Endocrinologists provide specialized knowledge for 5, 2, 6:
- Accurate diagnosis using morning cortisol, ACTH measurements, and cosyntropin stimulation testing
- Distinguishing primary from secondary adrenal insufficiency based on ACTH-cortisol relationships
- Optimizing glucocorticoid and mineralocorticoid replacement dosing
- Managing associated autoimmune conditions that occur in approximately 50% of patients with autoimmune primary adrenal insufficiency 6
- Educating patients on stress dosing and prevention of adrenal crisis
- Adjusting therapy during pregnancy, surgery, or critical illness 1, 7
Common Pitfall to Avoid
Do not assume that general practitioners or hospitalists can adequately manage adrenal insufficiency without endocrine input - the condition requires specialized knowledge of hormone replacement, stress dosing protocols, and recognition of subtle signs of under- or over-replacement 2, 7. Listening to well-informed adrenal patients who report needing additional steroids and taking urgent action in collaboration with their endocrinologist will avoid unnecessary deaths from this eminently treatable condition 1.