From the Guidelines
Addison's disease is diagnosed through a combination of blood tests, including measuring morning cortisol and ACTH levels, with low cortisol and high ACTH suggesting primary adrenal insufficiency, and confirmed by an ACTH stimulation test, as recommended by the consensus statement on the diagnosis, treatment and follow-up of patients with primary adrenal insufficiency 1.
Diagnosis
The diagnostic process for Addison's disease involves several steps, including:
- Measuring morning cortisol and ACTH levels, with low cortisol and high ACTH suggesting primary adrenal insufficiency 1
- An ACTH stimulation test, where synthetic ACTH (cosyntropin) is administered and cortisol levels are measured before and after; failure of cortisol to rise appropriately confirms the diagnosis 1
- Additional tests may include electrolyte panels (looking for low sodium and high potassium), antibody tests to check for autoimmune causes, and imaging such as CT scans to examine the adrenal glands 1
Symptoms
Symptoms of Addison's disease develop gradually and include:
- Fatigue, muscle weakness, weight loss, decreased appetite, salt cravings, low blood pressure, dizziness when standing, hyperpigmentation (darkening of skin), nausea, vomiting, abdominal pain, and mood changes like depression or irritability 1
- In acute adrenal crisis, symptoms become severe and may include severe pain, vomiting, diarrhea, low blood pressure, loss of consciousness, and can be life-threatening if not treated promptly with hydrocortisone injections and IV fluids 1
Treatment
Treatment for Addison's disease involves replacing the deficient hormones with medication, and may include:
- Hydrocortisone (HC) and fludrocortisone, with dosages adjusted based on individual patient needs 1
- Patient education on managing daily medications and situations of minor to moderate concurrent illnesses, and providing supplies to allow self-injection of parenteral HC 1
Follow-up
Follow-up care for patients with Addison's disease is crucial to monitor for potential complications and adjust treatment as needed, and may include:
- Regular review of health and well-being, measurement of weight, blood pressure and serum electrolytes, and occasional monitoring for the development of new autoimmune disorders 1
From the Research
Testing for Addison Disease
- To test for Addison disease, laboratory tests are necessary, including measurements of serum adrenocorticotropic hormone (ACTH), renin, cortisol, and aldosterone levels 2.
- Electrolyte imbalance disorders, such as hyponatremia, can also be indicative of the disease 2.
- Hypoosmolar hyponatremia and serum potassium levels in the upper limit of normal may be present in patients with Addison disease 2.