The physiology of adrenal insufficiency

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Ongoing protocols are designed to: 1) develop a normative range for the free cortisol and aldosterone responses to the 250 mcg Cortrosyn stimulation test in healthy volunteers and compare these responses to those of patients with known primary and secondary adrenal insufficiency 2) evaluate adrenal function in critically ill patients with septic shock using these tests and 3) evaluate the prevalence of adrenal insufficiency in patients receiving intermittent high doses of steroids. For study 3, patients undergoing bone marrow transplantation will undergo the cortrosyn tests as well as an insulin tolerance test at monthly intervals after receiving monthly high-dose glucocorticoids. 4)assess the effect of altered protein status on total and free cortisol levels in the evaluation of adrenal insufficiency in patients with cirrhosis and nephrotic syndrome. The protocols are not fully recruited and no interval information has been published.