"You're just tired and stressed.", what you've probably been told
Adrenal insufficiency
NHS guideline NG243 (2024) sets out how primary care should suspect, test for, and manage adrenal insufficiency, a condition that can be life-threatening if missed. The guideline is explicit about when a 9am cortisol and short Synacthen test should be requested.
The wait: Diagnosis often comes only after an adrenal crisis, sometimes years late.
What GPs miss
Adrenal insufficiency is frequently mistaken for chronic fatigue, depression, or 'medically unexplained' symptoms. NG243 lists the red-flag features that should prompt testing rather than reassurance.
The letter asks for
- A 9am serum cortisol and ACTH per NG243
- Referral for short Synacthen test where indicated
- Endocrinology referral if results are abnormal or borderline
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Frequently asked questions
My cortisol was 'normal', does that rule it out?
Not necessarily. NG243 sets out when a short Synacthen test or endocrinology referral should follow a borderline or symptomatic result. The letter cites this.
What you hear vs. what NG243 says
What's usually said in the room
"You're just tired and stressed."
What the guideline actually says
Adrenal insufficiency is frequently mistaken for chronic fatigue, depression, or 'medically unexplained' symptoms. NG243 lists the red-flag features that should prompt testing rather than reassurance.
Source: Adrenal insufficiency: identification and management (NG243)
Benefits and rights for Adrenal insufficiency
Outcomes from people with Adrenal insufficiency
One short email each Sunday, anonymised stories from people who got their GP to take them seriously.