Addison’s disease: Addisonian crisis and diagnosis

By considering signs and symptoms, inquiring about family history, and by medical testing, physicians diagnose Addison’s disease.

The signs of Addison’s disease are frequently nonspecific, often known as primary adrenal insufficiency. They contrast with signs of other diseases, in other words. This can make it a challenge to diagnose.

To diagnose Addison’s disease, a doctor will:

  • review the individual’s medical history
  • ask if any close relatives have an autoimmune disorder
  • ask about symptoms, when they began, and their effects on everyday life
  • carry out a physical examination
  • request tests, such as blood tests, urine tests, and a CT scan

We will discuss the most popular methods of diagnosis in this article and clarify how they function.

What’s behind Addison’s disease? Here, find out.

Medical history and symptoms

Blood test
A doctor may order a blood test to help diagnose Addison’s disease.

When a person visits their doctor for symptoms, a diagnosis of Addison’s disease may occur. However when a normal blood test shows unusual levels of sodium or potassium in the blood, the person can find out by chance.

In order to diagnose Addison’s disease, a doctor will take multiple steps.

Symptoms

The doctor may start by taking any signs and symptoms into consideration. An person with Addison’s disease may have:

The doctor may also look for hyperpigmentation, a darkening of the skin, in:

  • the creases in the elbows and palms of the hands
  • in scars
  • on the gums and lips

Typically, these changes happen gradually, but occasionally they can unexpectedly occur. If this happens, the person has acute adrenal failure. This is a medical emergency.

Read more about the signs of Addison’s disease here.

Tests

The person’s blood pressure is taken by a doctor. There is sometimes low blood pressure in people with Addison’s disease.

Blood and urine tests

An initial blood test may reveal:

  • low sodium levels, or hyponatremia
  • low glucose levels, or hypoglycemia
  • high potassium levels, or hyperkalemia

More specifics tests may assess:

  • morning cortisol levels in the blood
  • cortisol level in the saliva
  • aldosterone levels in the blood
  • adrenocorticotrophic hormone (ACTH) levels in the blood

More specific testing can help determine whether hormone levels are impaired by Addison’s or another disease.

What’s behind Addison’s disease? Here, find out.

ACTH stimulation test

If cortisol levels are low, or if symptoms indicate Addison’s disease, a doctor can prescribe an ACTH stimulation test. Typically, this test occurs in an endocrinology unit.

ACTH is produced by the pituitary gland, promoting the adrenal glands to secrete cortisol and aldosterone.

Cosyntropin is a version of ACTH that is synthetic. Cortrosyn and Synacthen comprise its trade names.

The adrenal glands should release cortisol into the blood when the doctor gives cosyntropin to the person. The tests would reveal cortisol and ACTH levels in the blood.

There will be multiple blood tests involved in the ACTH stimulation test. After 30 minutes and 60 minutes, there will be one test before the doctor offers cosyntropin and other tests. How the body reacts can be examined by the doctor.

The doctor would possibly diagnose Addison’s disease if ACTH levels are high and cortisol levels are low.

Thyroid function test

If a person has a problem with their thyroid gland, which produces hormones for growth and metabolism, blood tests will indicate.

An underactive thyroid may affect the hormone levels of an individual and can increase the likelihood that other autoimmune conditions may develop.

Antibody tests

Addison’s disease normally occurs when the immune system mistakenly begins to attack the adrenal gland of an individual.

Scientists agree that the illness and its antibodies can be present for months or even years before symptoms occur in a person.

Testing for antibodies might help confirm the diagnosis of Addison.

CT scan

Detailed images of the inside of the body, including the inner organs, can be created by a CT scan.

To check the size of the adrenal glands and whether any unusual features are present, the doctor may wish to scan the abdomen.

They can also examine the pituitary gland, as problems may lead to secondary adrenal insufficiency in this gland.

Other health conditions

According to the National Institutes of Health (NIH), people with the following disorders or problems may be more likely to develop Addison’s disease:

  • repeat infections
  • fungal infections
  • infections that occur with AIDS
  • genetic disorders
  • tumors and cancer
  • certain medications
  • tuberculosis

Along with Addison’s disease, other diseases may occur. A clear connection to these has not always been identified by study, although some can result from Addison’s disease.

Doctors diagnosed Addison’s disease as the underlying cause of kidney injury in a 37-year-old male in a 2016 case report.

Researchers found ties with in another inquiry, involving separate African countries.

  • hypothyroidism
  • type 1 diabetes
  • pernicious anemia
  • premature ovarian insufficiency
  • Graves’ disease

Conditions with similar symptoms

Other disorders which may have similar symptoms may also need to be excluded by the doctor. Secondary adrenal deficiency happens when another condition affects how the adrenal gland works.

Other conditions include:

  • pituitary tumors
  • lymphatic hypophystitis, an inflammation of the pituitary gland
  • pituitary tuberculosis
  • sarcoidosis, another immune condition

Treatment options will depend on the underlying condition.

Diagnosis during an Addisonian crisis

When symptoms are serious, an Addisonian crisis, also called an adrenal crisis or acute adrenal insufficiency, takes place. Suddenly, it can happen and be life threatening.

If a person does not have treatment or if they receive treatment but are stressed, it may happen. For instance, it may result from an accident or during surgery or a serious illness.

Symptoms of an Addisonian crisis include:

  • sudden weakness
  • severe pain
  • vomiting and diarrhea
  • fainting due to low blood pressure
  • shock
  • kidney failure

The person will need medical attention immediately.

The doctor will conduct blood tests and monitor the signs and symptoms in the same way, but the person will be treated before the results are returned.

Outlook

Addison’s disease is a chronic illness that can have a serious effect on the life of a person.

It can be worrisome to have a diagnosis, but it can also help:

  • establish a suitable treatment plan
  • recognize and manage symptoms
  • show what to do in case of an emergency

The NIH recommend:

  • following an appropriate treatment plan
  • staying hydrated
  • wearing a medical ID in case of an emergency

These measures will help a person escape a crisis and have a life expectancy that is normal.

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