Abstract Introduction: The hypothalamic-pituitary-adrenal (HPA) axis is a critical regulator of cortisol secretion, assessed via dynamic tests such as the insulin tolerance test and adrenocorticotropic hormone (ACTH) stimulation test. Discordant cortisol responses in recurrent hypoglycaemia that is, blunted secretion during hypoglycaemia but preserved under ACTH stimulation, pose a diagnostic challenge in evaluating adrenal insufficiency (AI). Methods: A retrospective study was conducted in five patients (two females, three males) with spontaneous fasting hypoglycaemia (blood glucose 18 μg/dL) post-ACTH stimulation. Conclusion: Low cortisol levels during recurrent hypoglycaemia should be interpreted cautiously, and AI should be diagnosed only after a comprehensive evaluation. A normal ACTH stimulation test can rule out AI assertively in such scenario. Further studies are needed to clarify the mechanisms of this discordance.
Machineni et al. (Thu,) studied this question.