Always correct ADRENAL (Cortisol) and THYROID axes first. Initiating levothyroxine in a patient with untreated adrenal insufficiency can precipitate an Adrenal Crisis.
Verified
Last Review: 2026
| Axis | Primary Screening Test | Confirmatory Test |
|---|---|---|
| Adrenal | 8AM Cortisol (≤ 3 µg/dL is definite) | ACTH Stimulation Test |
| Thyroid | TSH + Free T4 | TRH test (rarely used) |
| Gonadal | FSH, LH + Testosterone or Estradiol | GnRH stimulation (pediatrics) |
| Growth Hormone | IGF-1 (Age/Sex matched) | Glucagon or Insuln Tolerance Test |
| Posterior | Urine/Serum Osmolality | Water Deprivation Test |
Fleseriu M et al. • J Clin Endocrinol Metab. 2016;The comprehensive guideline on systematic workup and hormone replacement order.
Last Comprehensive Review: 2026
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Clinical Context
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Clinical Context
We think this has broad domain relevance to Hypopituitarism Axis Checklist.
