Materiały źródłowe

• #1 Addison Disease – StatPearls – NCBI Bookshelf

  https://www.ncbi.nlm.nih.gov/books/NBK441994/

  Addison disease usually manifests as an insidious and gradual onset of nonspecific symptoms, often resulting in a delayed diagnosis. […] A high clinical suspicion should be maintained to avoid misdiagnosis. […] In many cases, the diagnosis is made only after the patient presents with an acute adrenal crisis manifesting with hypotension, hyponatremia, hyperkalemia, and hypoglycemia. […] The diagnosis is established by demonstrating low cortisol and aldosterone levels, high renin levels, and a blunt cortisol response with ACTH stimulation. […] The diagnosis of Addison disease is established by demonstrating low cortisol and aldosterone levels, high renin levels, and a blunt cortisol response with ACTH stimulation. […] A low random cortisol level is characteristically seen with Addison disease.

• #2 Addison Disease Workup: Laboratory Studies, Imaging Studies, Other Tests

  https://emedicine.medscape.com/article/116467-workup

  A quick review of the clinical presentation, physical examination findings, and laboratory findings (when available) quickly heightens the index of suspicion and possibly leads to more appropriate tests and diagnosis. A high index of suspicion is necessary for diagnosis. […] The diagnosis of adrenocortical insufficiency rests on the assessment of the functional capacity of the adrenal cortex to synthesize cortisol. This is accomplished primarily by use of the rapid ACTH stimulation test (Cortrosyn, cosyntropin, or Synacthen). […] An increase in the plasma cortisol and aldosterone levels above basal levels after ACTH injection reflects the functional integrity of the adrenal cortex. […] Two criteria are necessary for diagnosis: (1) an increase in the baseline cortisol value of 7 mcg/dL or more and (2) the value must rise to 20 mcg/dL or more in 30 or 60 minutes, establishing normal adrenal glucocorticoid function.

• #3 Addison Disease | Treatment & Management | Point of Care

  https://www.statpearls.com/point-of-care/17183

  Addison disease usually manifests as an insidious and gradual onset of nonspecific symptoms, often resulting in a delayed diagnosis. […] A high clinical suspicion should be maintained to avoid misdiagnosis. […] In many cases, the diagnosis is made only after the patient presents with an acute adrenal crisis manifesting with hypotension, hyponatremia, hyperkalemia, and hypoglycemia. The diagnosis is established by demonstrating low cortisol and aldosterone levels, high renin levels, and a blunt cortisol response with ACTH stimulation. […] The diagnosis of Addison disease is established by demonstrating low cortisol and aldosterone levels, high renin levels, and a blunt cortisol response with ACTH stimulation. […] A low random cortisol level is characteristically seen with Addison disease.

• #4 Addison Disease Workup: Laboratory Studies, Imaging Studies, Other Tests

  https://emedicine.medscape.com/article/116467-workup

  A random plasma cortisol value of 25 mcg/dL or greater effectively excludes adrenal insufficiency of any kind. […] An abnormal test result should prompt a proper evaluation of the hypothalamic pituitary adrenal axis after the patient’s condition improves before committing a patient to lifelong steroid replacement. […] In order to perform the ACTH stimulation test in this situation, the patient should be switched to dexamethasone and then tested 24-36 hours later. […] The most prominent findings are hyponatremia, hyperkalemia, and a mild nonanion-gap metabolic acidosis due to the loss of the sodium-retaining and potassium and hydrogen ion-secreting action of aldosterone. […] CBC count may reveal a normocytic normochromic anemia, which, upon initial presentation, may be masked by dehydration and hemoconcentration.

• #5

  https://www.nhs.uk/conditions/addisons-disease/diagnosis/

  To help diagnose Addison’s disease, a GP will first ask about your symptoms and review your medical history. […] If Addison’s disease is suspected, blood tests will be carried out to measure the levels of sodium, potassium and cortisol in your body. A low sodium, high potassium or low cortisol level may indicate Addison’s disease. […] If cortisol in your blood is low or your symptoms strongly suggest Addison’s disease, you’ll need to have a synacthen stimulation test to confirm the diagnosis. […] If the ACTH level is high but the cortisol and aldosterone levels are low, it’s usually confirmation of Addison’s disease. […] If Addison’s disease is left untreated, it eventually leads to an adrenal crisis. This is where the symptoms of Addison’s disease appear quickly and severely. […] During an adrenal crisis, there’s not enough time to perform a synacthen stimulation test to confirm Addison’s disease.

• #6 Addison Disease – StatPearls – NCBI Bookshelf

  https://www.ncbi.nlm.nih.gov/books/NBK441994/

  The ACTH level is markedly elevated in primary adrenal insufficiency. […] In equivocal cases, the diagnosis is confirmed by an ACTH (ie, cosyntropin) stimulation test, which causes rapid stimulation of cortisol and aldosterone secretion. […] Serum renin and aldosterone levels should be obtained to determine whether a mineralocorticoid deficiency is present. […] Laboratory findings that are characteristic of Addison disease include hyponatremia, hyperkalemia, and hypoglycemia. […] The confirmatory laboratory evaluation should not delay the treatment. […] Addison crisis is a severe endocrine emergency; immediate recognition and treatment are required.

• #7 Addison Disease – Endocrine and Metabolic Disorders – Merck Manual Professional Edition

  https://www.merckmanuals.com/professional/endocrine-and-metabolic-disorders/adrenal-disorders/addison-disease

  Diagnosis is clinical and by finding elevated plasma adrenocorticotropic hormone (ACTH) with low plasma cortisol. […] Clinical symptoms and signs suggest adrenal insufficiency. Sometimes the diagnosis is considered only on discovery of characteristic abnormalities of serum electrolytes, including low sodium, high potassium, low bicarbonate, and high BUN (blood urea nitrogen). […] Laboratory tests, beginning with morning serum cortisol and plasma ACTH levels, confirm adrenal insufficiency. Elevated ACTH ( 50 pg/mL [ 11 pmol/L]) with low cortisol ( 5 mcg/dL [ 138 nmol/L]) is diagnostic, particularly in patients who are severely stressed or in shock. […] Addison disease is diagnosed by showing failure of exogenous ACTH to increase serum cortisol. […] If ACTH and cortisol levels are borderline and adrenal insufficiency is clinically suspected particularly in a patient who is about to undergo major surgery provocative testing must be done. […] Elevated ACTH levels together with low cortisol levels confirm the diagnosis.

• #8 Diagnosis of adrenal insufficiency in adults – UpToDate

  https://www.uptodate.com/contents/diagnosis-of-adrenal-insufficiency-in-adults

  Diagnosis of adrenal insufficiency in adults […] The diagnosis of adrenal insufficiency depends upon a critical level of clinical suspicion. Measurements of serum cortisol within three hours after wakening (eg, 6 to 9 AM) can suggest the diagnosis of adrenal insufficiency. However, these measurements often cannot definitively establish the presence or absence of adrenal insufficiency. The ACTH stimulation test is the best test to diagnose or exclude adrenal insufficiency when the baseline cortisol value is indeterminate. […] Diagnostic testing should be performed in adults with signs and symptoms of adrenal insufficiency. The symptoms of adrenal insufficiency may be subtle, and the diagnosis of adrenal insufficiency depends upon a critical level of clinical suspicion. […] For patients with suspected chronic adrenal insufficiency, we measure a serum cortisol level within three hours after wakening (eg, 6 to 9 AM). When the clinical suspicion for primary adrenal insufficiency is high, we obtain cortisol, ACTH, renin, and aldosterone levels simultaneously to expedite the diagnosis and determine the etiology. […] A standard high-dose (250 mcg) corticotropin (ACTH) stimulation test should be performed to establish the diagnosis of adrenal insufficiency in patients with indeterminate serum cortisol values in whom hypoadrenalism is suspected.

• #9 Testing for Addison’s disease

  https://www.dvm360.com/view/testing-addisons-disease

  Hypoadrenocorticism, or Addison’s disease, results from failure of the adrenal glands to secrete glucocorticoids (primarily cortisol) and mineralocorticoids (primarily aldosterone). […] An ACTH stimulation test is necessary to confirm a diagnosis of hypoadrenocorticism because not all dogs with hypoadrenocorticism have the expected electrolyte changes, and because many other disorders may mimic the characteristic findings of Addison’s disease. […] Measurement of a basal cortisol concentration is not adequate for confirmation of a diagnosis of hypoadrenocorticism, because some normal dogs have a low basal cortisol concentration but have an appropriate response to ACTH administration. […] In dogs with hypoadrenocorticism, both the pre-and post-ACTH cortisol concentrations usually are less than 1 mcg/dl, and both values should be less than the reference range for basal cortisol (usually 2 mcg/dl) to confirm the diagnosis. […] Measurement of an endogenous (basal) ACTH concentration is useful in identifying whether hypoadrenocorticism is primary or secondary.

• #10 Addison Disease: Early Detection and Treatment Principles | AAFP

  https://www.aafp.org/pubs/afp/issues/2014/0401/p563.html

  Autoimmune adrenalitis is a disorder in which the adrenal cortex is destroyed, resulting in the loss of mineralocorticoid, glucocorticoid, and adrenal androgen hormone production. […] Addison disease, or primary adrenal insufficiency, is diagnosed after confirming an elevated ACTH level and an inability to stimulate cortisol levels with a cosyntropin stimulation test. […] A cosyntropin stimulation test is the first-line test for diagnosing adrenal insufficiency. The serum cortisol, plasma ACTH, plasma aldosterone, and plasma renin levels should be measured before administering 250 mcg of ACTH. At 30 and 60 minutes after intravenous ACTH administration, the serum cortisol level should be measured again. A normal response occurs with peak cortisol levels greater than 18 to 20 mcg per dL (497 to 552 nmol per L); a smaller or absent response is diagnostic for adrenal insufficiency.

• #11 Addison Disease Workup: Laboratory Studies, Imaging Studies, Other Tests

  https://emedicine.medscape.com/article/116467-workup

  A quick review of the clinical presentation, physical examination findings, and laboratory findings (when available) quickly heightens the index of suspicion and possibly leads to more appropriate tests and diagnosis. A high index of suspicion is necessary for diagnosis. […] The diagnosis of adrenocortical insufficiency rests on the assessment of the functional capacity of the adrenal cortex to synthesize cortisol. This is accomplished primarily by use of the rapid ACTH stimulation test (Cortrosyn, cosyntropin, or Synacthen). […] An increase in the plasma cortisol and aldosterone levels above basal levels after ACTH injection reflects the functional integrity of the adrenal cortex. […] Two criteria are necessary for diagnosis: (1) an increase in the baseline cortisol value of 7 mcg/dL or more and (2) the value must rise to 20 mcg/dL or more in 30 or 60 minutes, establishing normal adrenal glucocorticoid function.

• #12 Diagnosis of Adrenal Insufficiency & Addison’s Disease – NIDDK

  https://www.niddk.nih.gov/health-information/endocrine-diseases/adrenal-insufficiency-addisons-disease/diagnosis

  Your doctor will review your symptoms and run tests to confirm that your cortisol levels are low. […] The next step is blood testing to see if your cortisol levels are too low and to help find the cause. […] The ACTH stimulation test is the test used most often to diagnose adrenal insufficiency. […] The normal response after an ACTH injection is a rise in blood cortisol levels. People with Addisons disease and most people who have had secondary adrenal insufficiency for a long time have little or no increase in cortisol levels. […] If the results of the ACTH stimulation test arent clear or your doctor suspects a problem in the pituitary, you may have an insulin tolerance test (ITT). […] The ITT is the most reliable test to diagnose secondary adrenal insufficiency. […] The CRH stimulation test is another option to help identify secondary insufficiency if the results of the ACTH test arent clear.

• #13 Addison Disease: Early Detection and Treatment Principles | AAFP

  https://www.aafp.org/pubs/afp/issues/2014/0401/p563.html

  Autoimmune adrenalitis is a disorder in which the adrenal cortex is destroyed, resulting in the loss of mineralocorticoid, glucocorticoid, and adrenal androgen hormone production. […] Addison disease, or primary adrenal insufficiency, is diagnosed after confirming an elevated ACTH level and an inability to stimulate cortisol levels with a cosyntropin stimulation test. […] A cosyntropin stimulation test is the first-line test for diagnosing adrenal insufficiency. The serum cortisol, plasma ACTH, plasma aldosterone, and plasma renin levels should be measured before administering 250 mcg of ACTH. At 30 and 60 minutes after intravenous ACTH administration, the serum cortisol level should be measured again. A normal response occurs with peak cortisol levels greater than 18 to 20 mcg per dL (497 to 552 nmol per L); a smaller or absent response is diagnostic for adrenal insufficiency.

• #14 Diagnosis of Adrenal Insufficiency & Addison’s Disease – NIDDK

  https://www.niddk.nih.gov/health-information/endocrine-diseases/adrenal-insufficiency-addisons-disease/diagnosis

  Your doctor will review your symptoms and run tests to confirm that your cortisol levels are low. […] The next step is blood testing to see if your cortisol levels are too low and to help find the cause. […] The ACTH stimulation test is the test used most often to diagnose adrenal insufficiency. […] The normal response after an ACTH injection is a rise in blood cortisol levels. People with Addisons disease and most people who have had secondary adrenal insufficiency for a long time have little or no increase in cortisol levels. […] If the results of the ACTH stimulation test arent clear or your doctor suspects a problem in the pituitary, you may have an insulin tolerance test (ITT). […] The ITT is the most reliable test to diagnose secondary adrenal insufficiency. […] The CRH stimulation test is another option to help identify secondary insufficiency if the results of the ACTH test arent clear.

• #15 Addison Disease: Early Detection and Treatment Principles | AAFP

  https://www.aafp.org/pubs/afp/issues/2014/0401/p563.html

  Autoimmune adrenalitis is a disorder in which the adrenal cortex is destroyed, resulting in the loss of mineralocorticoid, glucocorticoid, and adrenal androgen hormone production. […] Addison disease, or primary adrenal insufficiency, is diagnosed after confirming an elevated ACTH level and an inability to stimulate cortisol levels with a cosyntropin stimulation test. […] A cosyntropin stimulation test is the first-line test for diagnosing adrenal insufficiency. The serum cortisol, plasma ACTH, plasma aldosterone, and plasma renin levels should be measured before administering 250 mcg of ACTH. At 30 and 60 minutes after intravenous ACTH administration, the serum cortisol level should be measured again. A normal response occurs with peak cortisol levels greater than 18 to 20 mcg per dL (497 to 552 nmol per L); a smaller or absent response is diagnostic for adrenal insufficiency.

• #16 Addison Disease Workup: Laboratory Studies, Imaging Studies, Other Tests

  https://emedicine.medscape.com/article/116467-workup

  A normal 30- or 60-minute rapid ACTH test excludes Addison disease but may not adequately exclude mild impairment of the hypothalamic pituitary adrenal axis in secondary adrenal insufficiency. […] In patients with Addison disease, both cortisol and aldosterone show minimal or no change in response to ACTH, even with prolonged ACTH stimulation tests lasting 24-48 hours. […] When the results of the rapid ACTH test are equivocal and do not meet the 2 criteria mentioned above, further testing might be required to distinguish Addison disease from secondary adrenocortical insufficiency. […] ACTH levels often are elevated to higher than 250 pg/mL in patients with Addison disease. […] In acute adrenal crisis, where treatment should not be delayed in order to do the tests, a blood sample for a random plasma cortisol level should be drawn prior to starting hydrocortisone replacement.

• #17 Addison Disease Workup: Laboratory Studies, Imaging Studies, Other Tests

  https://emedicine.medscape.com/article/116467-workup

  A quick review of the clinical presentation, physical examination findings, and laboratory findings (when available) quickly heightens the index of suspicion and possibly leads to more appropriate tests and diagnosis. A high index of suspicion is necessary for diagnosis. […] The diagnosis of adrenocortical insufficiency rests on the assessment of the functional capacity of the adrenal cortex to synthesize cortisol. This is accomplished primarily by use of the rapid ACTH stimulation test (Cortrosyn, cosyntropin, or Synacthen). […] An increase in the plasma cortisol and aldosterone levels above basal levels after ACTH injection reflects the functional integrity of the adrenal cortex. […] Two criteria are necessary for diagnosis: (1) an increase in the baseline cortisol value of 7 mcg/dL or more and (2) the value must rise to 20 mcg/dL or more in 30 or 60 minutes, establishing normal adrenal glucocorticoid function.

• #18 Addison Disease Workup: Laboratory Studies, Imaging Studies, Other Tests

  https://emedicine.medscape.com/article/116467-workup

  A normal 30- or 60-minute rapid ACTH test excludes Addison disease but may not adequately exclude mild impairment of the hypothalamic pituitary adrenal axis in secondary adrenal insufficiency. […] In patients with Addison disease, both cortisol and aldosterone show minimal or no change in response to ACTH, even with prolonged ACTH stimulation tests lasting 24-48 hours. […] When the results of the rapid ACTH test are equivocal and do not meet the 2 criteria mentioned above, further testing might be required to distinguish Addison disease from secondary adrenocortical insufficiency. […] ACTH levels often are elevated to higher than 250 pg/mL in patients with Addison disease. […] In acute adrenal crisis, where treatment should not be delayed in order to do the tests, a blood sample for a random plasma cortisol level should be drawn prior to starting hydrocortisone replacement.

• #19 Addison Disease Workup: Laboratory Studies, Imaging Studies, Other Tests

  https://emedicine.medscape.com/article/116467-workup

  A random plasma cortisol value of 25 mcg/dL or greater effectively excludes adrenal insufficiency of any kind. […] An abnormal test result should prompt a proper evaluation of the hypothalamic pituitary adrenal axis after the patient’s condition improves before committing a patient to lifelong steroid replacement. […] In order to perform the ACTH stimulation test in this situation, the patient should be switched to dexamethasone and then tested 24-36 hours later. […] The most prominent findings are hyponatremia, hyperkalemia, and a mild nonanion-gap metabolic acidosis due to the loss of the sodium-retaining and potassium and hydrogen ion-secreting action of aldosterone. […] CBC count may reveal a normocytic normochromic anemia, which, upon initial presentation, may be masked by dehydration and hemoconcentration.

• #20 Addison Disease Workup: Laboratory Studies, Imaging Studies, Other Tests

  https://emedicine.medscape.com/article/116467-workup

  A normal 30- or 60-minute rapid ACTH test excludes Addison disease but may not adequately exclude mild impairment of the hypothalamic pituitary adrenal axis in secondary adrenal insufficiency. […] In patients with Addison disease, both cortisol and aldosterone show minimal or no change in response to ACTH, even with prolonged ACTH stimulation tests lasting 24-48 hours. […] When the results of the rapid ACTH test are equivocal and do not meet the 2 criteria mentioned above, further testing might be required to distinguish Addison disease from secondary adrenocortical insufficiency. […] ACTH levels often are elevated to higher than 250 pg/mL in patients with Addison disease. […] In acute adrenal crisis, where treatment should not be delayed in order to do the tests, a blood sample for a random plasma cortisol level should be drawn prior to starting hydrocortisone replacement.

• #21 Addison Disease | Treatment & Management | Point of Care

  https://www.statpearls.com/point-of-care/17183

  The ACTH level is markedly elevated in primary adrenal insufficiency. […] In equivocal cases, the diagnosis is confirmed by an ACTH (ie, cosyntropin) stimulation test, which causes rapid stimulation of cortisol and aldosterone secretion. […] Serum renin and aldosterone levels should be obtained to determine whether a mineralocorticoid deficiency is present. […] Laboratory findings that are characteristic of Addison disease include hyponatremia, hyperkalemia, and hypoglycemia. […] The confirmatory laboratory evaluation should not delay the treatment. […] Addison crisis is a severe endocrine emergency; immediate recognition and treatment are required.

• #22

  https://www.nhs.uk/conditions/addisons-disease/diagnosis/

  To help diagnose Addison’s disease, a GP will first ask about your symptoms and review your medical history. […] If Addison’s disease is suspected, blood tests will be carried out to measure the levels of sodium, potassium and cortisol in your body. A low sodium, high potassium or low cortisol level may indicate Addison’s disease. […] If cortisol in your blood is low or your symptoms strongly suggest Addison’s disease, you’ll need to have a synacthen stimulation test to confirm the diagnosis. […] If the ACTH level is high but the cortisol and aldosterone levels are low, it’s usually confirmation of Addison’s disease. […] If Addison’s disease is left untreated, it eventually leads to an adrenal crisis. This is where the symptoms of Addison’s disease appear quickly and severely. […] During an adrenal crisis, there’s not enough time to perform a synacthen stimulation test to confirm Addison’s disease.

• #23

  https://www2.hse.ie/conditions/addisons-disease/diagnosis/

  To help diagnose Addisons disease, your GP will first ask about your symptoms and review your medical history. […] If Addisons disease is suspected, blood tests will be carried out. These are to measure the levels of sodium, potassium and cortisol in your body. A low sodium, high potassium or low cortisol level may indicate Addisons disease. […] You may need to have a synacthen stimulation test to confirm a diagnosis of Addison’s disease. This is done if cortisol in your blood is low, or your symptoms strongly suggest Addisons disease. […] If the ACTH level is high, but the cortisol and aldosterone levels are low, it’s usually confirmation of Addisons disease. […] If Addisons disease is left untreated, it eventually leads to an adrenal crisis. This is where the symptoms of Addisons disease appear quickly and severely.

• #24 Adrenal Insufficiency | Choose the Right Test

  https://arupconsult.com/content/adrenal-insufficiency

  Once a diagnosis of adrenal insufficiency has been established, further testing should be performed to identify the underlying cause of the insufficiency and determine other medical implications. […] Simultaneous measurement of aldosterone and plasma renin is recommended in cases of adrenal insufficiency to determine whether the patient has mineralocorticoid deficiency. […] A positive 21-hydroxylase antibody test result confirms an autoimmune etiology of PAI, in which the body’s own immune response attacks adrenal tissue. […] For infants and also children and adults with PAI with suspected CAH, consider 17-hydroxyprogesterone testing to determine if CAH or a genetic syndrome is the etiology. […] In cases of secondary adrenal insufficiency, assess the hypothalamic-pituitary axis with imaging.

• #25 Addison’s Disease: Symptoms, Causes, & Treatment

  https://www.webmd.com/a-to-z-guides/understanding-addisons-disease-basics

  Blood test results that point to Addison’s disease include a low sodium or high potassium level, anemia (low iron), or a high level of eosinophils (a kind of white blood cell). Often, it’s first found through regular blood tests in a hospital or doctor’s office. The doctor will also check for hyperpigmentation, or darkening, of the skin or gums — a sign of long-term Addison’s disease. […] The most definitive way to diagnose Addisons is to measure hormone levels in the blood before and after giving ACTH. ACTH is a hormone released in the brain that normally increases cortisol release from the adrenal glands. With Addison’s disease, the adrenal glands cannot respond to ACTH stimulation, and cortisol levels remain low. Measuring cortisol and ACTH levels can help determine whether adrenal insufficiency is there, and if so, whether the problem is with the adrenal glands or brain. […] An evaluation of Addison’s disease can include a CT scan of the adrenal glands to look for infection, cancer, or bleeding in the adrenal glands. A tuberculosis test may also be done because up to 20% of cases are caused by tuberculosis. But the majority of cases are autoimmune.

• #26 Addison Disease | Treatment & Management | Point of Care

  https://www.statpearls.com/point-of-care/17183

  The ACTH level is markedly elevated in primary adrenal insufficiency. […] In equivocal cases, the diagnosis is confirmed by an ACTH (ie, cosyntropin) stimulation test, which causes rapid stimulation of cortisol and aldosterone secretion. […] Serum renin and aldosterone levels should be obtained to determine whether a mineralocorticoid deficiency is present. […] Laboratory findings that are characteristic of Addison disease include hyponatremia, hyperkalemia, and hypoglycemia. […] The confirmatory laboratory evaluation should not delay the treatment. […] Addison crisis is a severe endocrine emergency; immediate recognition and treatment are required.

• #27 Addison Disease – StatPearls – NCBI Bookshelf

  https://www.ncbi.nlm.nih.gov/books/NBK441994/

  The ACTH level is markedly elevated in primary adrenal insufficiency. […] In equivocal cases, the diagnosis is confirmed by an ACTH (ie, cosyntropin) stimulation test, which causes rapid stimulation of cortisol and aldosterone secretion. […] Serum renin and aldosterone levels should be obtained to determine whether a mineralocorticoid deficiency is present. […] Laboratory findings that are characteristic of Addison disease include hyponatremia, hyperkalemia, and hypoglycemia. […] The confirmatory laboratory evaluation should not delay the treatment. […] Addison crisis is a severe endocrine emergency; immediate recognition and treatment are required.

• #28 Addison Disease: Early Detection and Treatment Principles | AAFP

  https://www.aafp.org/pubs/afp/issues/2014/0401/p563.html

  Measurement of 21-hydroxylase antibody levels helps discern the cause of Addison disease. The 21-hydroxylase enzyme is necessary for cortisol synthesis in the adrenal cortex; antibodies directed against the enzyme are specific for autoimmune adrenalitis and are detectable before symptom onset. […] Radiographic imaging is also helpful in determining the cause of Addison disease, but it is relatively nonspecific in patients with autoimmune destruction. It is important to make a biochemical diagnosis of adrenal insufficiency before radiographic imaging. Computed tomography demonstrates small adrenal glands in patients with autoimmune adrenal destruction. In other causes of Addison disease, computed tomography may show hemorrhage, calcification associated with tuberculosis infection, or masses in the adrenal gland. However, computed tomography is not necessary to diagnose adrenal insufficiency.

• #29 Adrenal Insufficiency | Choose the Right Test

  https://arupconsult.com/content/adrenal-insufficiency

  Once a diagnosis of adrenal insufficiency has been established, further testing should be performed to identify the underlying cause of the insufficiency and determine other medical implications. […] Simultaneous measurement of aldosterone and plasma renin is recommended in cases of adrenal insufficiency to determine whether the patient has mineralocorticoid deficiency. […] A positive 21-hydroxylase antibody test result confirms an autoimmune etiology of PAI, in which the body’s own immune response attacks adrenal tissue. […] For infants and also children and adults with PAI with suspected CAH, consider 17-hydroxyprogesterone testing to determine if CAH or a genetic syndrome is the etiology. […] In cases of secondary adrenal insufficiency, assess the hypothalamic-pituitary axis with imaging.

• #30 Diagnosis of Adrenal Insufficiency & Addison’s Disease – NIDDK

  https://www.niddk.nih.gov/health-information/endocrine-diseases/adrenal-insufficiency-addisons-disease/diagnosis

  Your doctor will review your symptoms and run tests to confirm that your cortisol levels are low. […] The next step is blood testing to see if your cortisol levels are too low and to help find the cause. […] The ACTH stimulation test is the test used most often to diagnose adrenal insufficiency. […] The normal response after an ACTH injection is a rise in blood cortisol levels. People with Addisons disease and most people who have had secondary adrenal insufficiency for a long time have little or no increase in cortisol levels. […] If the results of the ACTH stimulation test arent clear or your doctor suspects a problem in the pituitary, you may have an insulin tolerance test (ITT). […] The ITT is the most reliable test to diagnose secondary adrenal insufficiency. […] The CRH stimulation test is another option to help identify secondary insufficiency if the results of the ACTH test arent clear.

• #31 Addison’s disease – Diagnosis and treatment – Mayo Clinic

  https://www.mayoclinic.org/diseases-conditions/addisons-disease/diagnosis-treatment/drc-20350296

  Diagnosis involves the steps that your healthcare team takes to find out if you have Addison’s disease. Your healthcare professional talks with you about your medical history and your symptoms. You might have some of the following tests that check for Addison’s disease or for secondary adrenal insufficiency: […] Blood test. This test can measure blood levels of sodium, potassium, cortisol and adrenocorticotropic hormone (ACTH). A blood test also can measure proteins called antibodies related to Addison’s disease caused by an autoimmune disease. […] ACTH stimulation test. ACTH tells the adrenal glands to make cortisol. This test measures the level of cortisol in the blood before and after a shot of lab-made ACTH. […] Insulin-induced hypoglycemia test. This test is done to find out if the pituitary gland is causing secondary adrenal insufficiency. The test involves checking blood sugar and cortisol levels after a shot of insulin. […] Imaging tests. A CT scan of the stomach area checks the size of the adrenal glands and looks for other issues. An MRI of the pituitary gland can spot damage that may cause secondary adrenal insufficiency.

• #32 Diagnosis of Adrenal Insufficiency & Addison’s Disease – NIDDK

  https://www.niddk.nih.gov/health-information/endocrine-diseases/adrenal-insufficiency-addisons-disease/diagnosis

  Your doctor will review your symptoms and run tests to confirm that your cortisol levels are low. […] The next step is blood testing to see if your cortisol levels are too low and to help find the cause. […] The ACTH stimulation test is the test used most often to diagnose adrenal insufficiency. […] The normal response after an ACTH injection is a rise in blood cortisol levels. People with Addisons disease and most people who have had secondary adrenal insufficiency for a long time have little or no increase in cortisol levels. […] If the results of the ACTH stimulation test arent clear or your doctor suspects a problem in the pituitary, you may have an insulin tolerance test (ITT). […] The ITT is the most reliable test to diagnose secondary adrenal insufficiency. […] The CRH stimulation test is another option to help identify secondary insufficiency if the results of the ACTH test arent clear.

• #33 Addison Disease: Early Detection and Treatment Principles | AAFP

  https://www.aafp.org/pubs/afp/issues/2014/0401/p563.html

  Measurement of 21-hydroxylase antibody levels helps discern the cause of Addison disease. The 21-hydroxylase enzyme is necessary for cortisol synthesis in the adrenal cortex; antibodies directed against the enzyme are specific for autoimmune adrenalitis and are detectable before symptom onset. […] Radiographic imaging is also helpful in determining the cause of Addison disease, but it is relatively nonspecific in patients with autoimmune destruction. It is important to make a biochemical diagnosis of adrenal insufficiency before radiographic imaging. Computed tomography demonstrates small adrenal glands in patients with autoimmune adrenal destruction. In other causes of Addison disease, computed tomography may show hemorrhage, calcification associated with tuberculosis infection, or masses in the adrenal gland. However, computed tomography is not necessary to diagnose adrenal insufficiency.

• #34 Diagnosis of Adrenal Insufficiency & Addison’s Disease – NIDDK

  https://www.niddk.nih.gov/health-information/endocrine-diseases/adrenal-insufficiency-addisons-disease/diagnosis

  A blood test can find antibodies that are present in autoimmune Addisons disease. […] A CT scan of the abdomen can find changes in your adrenal glands. […] Enlarged adrenal glands or a buildup of calcium in the glands can occur when Addisons disease is caused by infection, bleeding in the adrenal glands, or cancer cells in the glands. […] An MRI can look for changes in your pituitary and hypothalamus, such as large, noncancerous pituitary tumors.

• #35 Addison’s disease – Diagnosis and treatment – Mayo Clinic

  https://www.mayoclinic.org/diseases-conditions/addisons-disease/diagnosis-treatment/drc-20350296

  Diagnosis involves the steps that your healthcare team takes to find out if you have Addison’s disease. Your healthcare professional talks with you about your medical history and your symptoms. You might have some of the following tests that check for Addison’s disease or for secondary adrenal insufficiency: […] Blood test. This test can measure blood levels of sodium, potassium, cortisol and adrenocorticotropic hormone (ACTH). A blood test also can measure proteins called antibodies related to Addison’s disease caused by an autoimmune disease. […] ACTH stimulation test. ACTH tells the adrenal glands to make cortisol. This test measures the level of cortisol in the blood before and after a shot of lab-made ACTH. […] Insulin-induced hypoglycemia test. This test is done to find out if the pituitary gland is causing secondary adrenal insufficiency. The test involves checking blood sugar and cortisol levels after a shot of insulin. […] Imaging tests. A CT scan of the stomach area checks the size of the adrenal glands and looks for other issues. An MRI of the pituitary gland can spot damage that may cause secondary adrenal insufficiency.

• #36 Addison Disease: Early Detection and Treatment Principles | AAFP

  https://www.aafp.org/pubs/afp/issues/2014/0401/p563.html

  Measurement of 21-hydroxylase antibody levels helps discern the cause of Addison disease. The 21-hydroxylase enzyme is necessary for cortisol synthesis in the adrenal cortex; antibodies directed against the enzyme are specific for autoimmune adrenalitis and are detectable before symptom onset. […] Radiographic imaging is also helpful in determining the cause of Addison disease, but it is relatively nonspecific in patients with autoimmune destruction. It is important to make a biochemical diagnosis of adrenal insufficiency before radiographic imaging. Computed tomography demonstrates small adrenal glands in patients with autoimmune adrenal destruction. In other causes of Addison disease, computed tomography may show hemorrhage, calcification associated with tuberculosis infection, or masses in the adrenal gland. However, computed tomography is not necessary to diagnose adrenal insufficiency.

• #37 Addison Disease Workup: Laboratory Studies, Imaging Studies, Other Tests

  https://emedicine.medscape.com/article/116467-workup

  Increased thyroid-stimulating hormone (TSH), with or without low thyroxine, with or without associated thyroid autoantibodies, and with or without symptoms of hypothyroidism, may occur in patients with Addison disease and in patients with secondary adrenocortical insufficiency due to isolated ACTH deficiency. […] Modest hyperprolactinemia has been reported in cases of Addison disease and also in secondary adrenocortical insufficiency. […] The chest radiograph may be normal but often reveals a small heart. […] Abdominal CT scan may be normal but may show bilateral enlargement of the adrenal glands in patients with Addison disease because of TB, fungal infections, adrenal hemorrhage, or infiltrating diseases involving the adrenal glands. […] In cases due to idiopathic autoimmune adrenocortical atrophy, the adrenal glands usually are atrophic, with marked lymphocytic infiltration and fibrosis of the adrenal capsule.

• #38 Diagnosis of Adrenal Insufficiency & Addison’s Disease – NIDDK

  https://www.niddk.nih.gov/health-information/endocrine-diseases/adrenal-insufficiency-addisons-disease/diagnosis

  A blood test can find antibodies that are present in autoimmune Addisons disease. […] A CT scan of the abdomen can find changes in your adrenal glands. […] Enlarged adrenal glands or a buildup of calcium in the glands can occur when Addisons disease is caused by infection, bleeding in the adrenal glands, or cancer cells in the glands. […] An MRI can look for changes in your pituitary and hypothalamus, such as large, noncancerous pituitary tumors.

• #39 Addison’s disease – Diagnosis and treatment – Mayo Clinic

  https://www.mayoclinic.org/diseases-conditions/addisons-disease/diagnosis-treatment/drc-20350296

  Diagnosis involves the steps that your healthcare team takes to find out if you have Addison’s disease. Your healthcare professional talks with you about your medical history and your symptoms. You might have some of the following tests that check for Addison’s disease or for secondary adrenal insufficiency: […] Blood test. This test can measure blood levels of sodium, potassium, cortisol and adrenocorticotropic hormone (ACTH). A blood test also can measure proteins called antibodies related to Addison’s disease caused by an autoimmune disease. […] ACTH stimulation test. ACTH tells the adrenal glands to make cortisol. This test measures the level of cortisol in the blood before and after a shot of lab-made ACTH. […] Insulin-induced hypoglycemia test. This test is done to find out if the pituitary gland is causing secondary adrenal insufficiency. The test involves checking blood sugar and cortisol levels after a shot of insulin. […] Imaging tests. A CT scan of the stomach area checks the size of the adrenal glands and looks for other issues. An MRI of the pituitary gland can spot damage that may cause secondary adrenal insufficiency.

• #40 Addison Disease – StatPearls – NCBI Bookshelf

  https://www.ncbi.nlm.nih.gov/books/NBK441994/

  The ACTH level is markedly elevated in primary adrenal insufficiency. […] In equivocal cases, the diagnosis is confirmed by an ACTH (ie, cosyntropin) stimulation test, which causes rapid stimulation of cortisol and aldosterone secretion. […] Serum renin and aldosterone levels should be obtained to determine whether a mineralocorticoid deficiency is present. […] Laboratory findings that are characteristic of Addison disease include hyponatremia, hyperkalemia, and hypoglycemia. […] The confirmatory laboratory evaluation should not delay the treatment. […] Addison crisis is a severe endocrine emergency; immediate recognition and treatment are required.

• #41 Adrenal insufficiency – Knowledge @ AMBOSS

  https://www.amboss.com/us/knowledge/adrenal-insufficiency/

  Primary adrenal insufficiency: Screen for hypoaldosteronism and hypoandrogenism. […] Endocrine testing: Consider if the diagnosis is uncertain (e.g., first presentation). […] ACTH stimulation test: diagnostic confirmation once the patient has been stabilized (see Diagnostics). […] Adrenal crisis can be life-threatening, so treatment with high doses of hydrocortisone should be started immediately, without waiting for diagnostic confirmation of hypocortisolism!

• #42 Addison’s disease | NHS inform

  https://www.nhsinform.scot/illnesses-and-conditions/glands/addisons-disease/

  Your thyroid gland may also be tested to see if its working properly. […] In some cases, your specialist may refer you for a scan of your adrenal glands. […] If Addisons disease is left untreated, it eventually leads to an adrenal crisis. […] During an adrenal crisis, theres not enough time to perform a synacthen stimulation test to confirm Addisons disease. […] If possible, blood will be taken and tested for any of the abnormalities listed above.

• #43 Addison Disease Workup: Laboratory Studies, Imaging Studies, Other Tests

  https://emedicine.medscape.com/article/116467-workup

  A normal 30- or 60-minute rapid ACTH test excludes Addison disease but may not adequately exclude mild impairment of the hypothalamic pituitary adrenal axis in secondary adrenal insufficiency. […] In patients with Addison disease, both cortisol and aldosterone show minimal or no change in response to ACTH, even with prolonged ACTH stimulation tests lasting 24-48 hours. […] When the results of the rapid ACTH test are equivocal and do not meet the 2 criteria mentioned above, further testing might be required to distinguish Addison disease from secondary adrenocortical insufficiency. […] ACTH levels often are elevated to higher than 250 pg/mL in patients with Addison disease. […] In acute adrenal crisis, where treatment should not be delayed in order to do the tests, a blood sample for a random plasma cortisol level should be drawn prior to starting hydrocortisone replacement.

• #44 Addison Disease Workup: Laboratory Studies, Imaging Studies, Other Tests

  https://emedicine.medscape.com/article/116467-workup

  A random plasma cortisol value of 25 mcg/dL or greater effectively excludes adrenal insufficiency of any kind. […] An abnormal test result should prompt a proper evaluation of the hypothalamic pituitary adrenal axis after the patient’s condition improves before committing a patient to lifelong steroid replacement. […] In order to perform the ACTH stimulation test in this situation, the patient should be switched to dexamethasone and then tested 24-36 hours later. […] The most prominent findings are hyponatremia, hyperkalemia, and a mild nonanion-gap metabolic acidosis due to the loss of the sodium-retaining and potassium and hydrogen ion-secreting action of aldosterone. […] CBC count may reveal a normocytic normochromic anemia, which, upon initial presentation, may be masked by dehydration and hemoconcentration.

• #45 Addison’s Disease: What It Is, Causes, Symptoms & Treatment

  https://my.clevelandclinic.org/health/diseases/15095-addisons-disease

  Since symptoms of Addisons disease usually develop slowly over time and are usually vague and common to many different conditions, it often leads to a delay in the proper diagnosis. […] If your provider suspects you may have Addisons disease based on your symptoms, theyll order more tests to officially diagnose the condition. […] To determine if you have Addisons disease, your healthcare provider may order the following tests: […] Your provider will likely order certain tests to measure the levels of sodium, potassium, cortisol and ACTH in your blood. […] This test measures your adrenal glands response after youre given a shot of artificial ACTH. If your adrenal glands produce low levels of cortisol after the shot, they may not be functioning properly. […] Your provider may order a CT scan to evaluate your adrenal glands and/or pituitary gland. For example, it can show if your immune system has damaged your adrenal glands or if the glands are infected.

• #46 Missed Diagnosis of Addison’s Disease in Adolescent Presenting with Fatigue. | PSNet

  https://psnet.ahrq.gov/web-mm/missed-diagnosis-addisons-disease-adolescent-presenting-fatigue

  A 13-year-old girl developed fatigue, weight loss, and a persistent upper respiratory infection over a three-week period. […] She was diagnosed as having either mono-spot negative mononucleosis or culture-negative and ASO-negative strep throat. […] She was successfully resuscitated and airlifted to a tertiary care hospital where the medical team diagnosed her as having an adrenal crisis, later confirmed to be secondary to autoimmune primary adrenal failure or Addisons disease. […] This is a tragic case of a 13-year-old girl whose death due to complications of adrenal crisis was entirely preventable. She presented to several health care providers with typical symptoms, physical signs, and early laboratory findings suggestive of adrenal insufficiency (AI). Yet the diagnosis was delayed for several months due to classic errors in the diagnostic process; premature closure on a more common pediatric diagnosis; availability bias due to providers lack of experience with endocrinologic causes of fatigue and weight loss; and anchoring bias in their failure to consider new diagnostic possibilities despite persistent and worsening symptoms.

• #47 Missed Diagnosis of Addison’s Disease in Adolescent Presenting with Fatigue. | PSNet

  https://psnet.ahrq.gov/web-mm/missed-diagnosis-addisons-disease-adolescent-presenting-fatigue

  Symptoms of acute adrenal crisis may include vomiting, diarrhea, severe abdominal pain (which can mimic an acute abdomen), fever, neuromuscular weakness, syncope, and confusion. […] Evaluation for AI is complicated by the fact that cortisol secretion is both diurnal and pulsatile, so cortisol levels at random times are often low and of little diagnostic value. […] A low cortisol level (5 ug/dl) paired with an ACTH level greater than two times the upper limit of normal is sufficient to diagnose primary AI, while a cortisol level between 5-14 ug/dl with clinical suspicion for AI should prompt ACTH stimulation testing. […] Testing for adrenal insufficiency can prove difficult in the acute setting. […] If adrenal insufficiency is suspected and the patient is not in adrenal crisis at presentation, then targeted testing should be performed under the guidance of an endocrinologist, if available.

• #48 Missed Diagnosis of Addison’s Disease in Adolescent Presenting with Fatigue. | PSNet

  https://psnet.ahrq.gov/web-mm/missed-diagnosis-addisons-disease-adolescent-presenting-fatigue

  A 13-year-old girl developed fatigue, weight loss, and a persistent upper respiratory infection over a three-week period. […] She was diagnosed as having either mono-spot negative mononucleosis or culture-negative and ASO-negative strep throat. […] She was successfully resuscitated and airlifted to a tertiary care hospital where the medical team diagnosed her as having an adrenal crisis, later confirmed to be secondary to autoimmune primary adrenal failure or Addisons disease. […] This is a tragic case of a 13-year-old girl whose death due to complications of adrenal crisis was entirely preventable. She presented to several health care providers with typical symptoms, physical signs, and early laboratory findings suggestive of adrenal insufficiency (AI). Yet the diagnosis was delayed for several months due to classic errors in the diagnostic process; premature closure on a more common pediatric diagnosis; availability bias due to providers lack of experience with endocrinologic causes of fatigue and weight loss; and anchoring bias in their failure to consider new diagnostic possibilities despite persistent and worsening symptoms.

• #49 Missed Diagnosis of Addison’s Disease in Adolescent Presenting with Fatigue. | PSNet

  https://psnet.ahrq.gov/web-mm/missed-diagnosis-addisons-disease-adolescent-presenting-fatigue

  Adrenal insufficiency (AI) may occur at the level of the adrenal glands (primary), the pituitary gland (secondary) or the hypothalamus (tertiary). […] Primary AI is rare affecting on the order of 1 in 10,000 individuals and can be related to autoimmune destruction, infiltration/injury (hemorrhage, trauma, infection), underlying genetic or metabolic disorders, or medication effects. […] Common symptoms of AI include anorexia, weight loss, nausea, abdominal discomfort, fatigue, postural dizziness, headaches, and non-specific muscle and joint pain. […] Adrenal insufficiency often presents as a slow, progressive illness over many months. […] Delay in diagnosis of AI is common the mean duration of symptoms prior to diagnosis was 5.6 months in one large pediatric cohort and can lead to significant morbidity and mortality if the patient suffers an acute adrenal crisis.

• #50 Missed Diagnosis of Addison’s Disease in Adolescent Presenting with Fatigue. | PSNet

  https://psnet.ahrq.gov/web-mm/missed-diagnosis-addisons-disease-adolescent-presenting-fatigue

  Adrenal insufficiency (AI) may occur at the level of the adrenal glands (primary), the pituitary gland (secondary) or the hypothalamus (tertiary). […] Primary AI is rare affecting on the order of 1 in 10,000 individuals and can be related to autoimmune destruction, infiltration/injury (hemorrhage, trauma, infection), underlying genetic or metabolic disorders, or medication effects. […] Common symptoms of AI include anorexia, weight loss, nausea, abdominal discomfort, fatigue, postural dizziness, headaches, and non-specific muscle and joint pain. […] Adrenal insufficiency often presents as a slow, progressive illness over many months. […] Delay in diagnosis of AI is common the mean duration of symptoms prior to diagnosis was 5.6 months in one large pediatric cohort and can lead to significant morbidity and mortality if the patient suffers an acute adrenal crisis.

• #51 Diagnosis of adrenal insufficiency in adults – UpToDate

  https://www.uptodate.com/contents/diagnosis-of-adrenal-insufficiency-in-adults

  Diagnosis of adrenal insufficiency in adults […] The diagnosis of adrenal insufficiency depends upon a critical level of clinical suspicion. Measurements of serum cortisol within three hours after wakening (eg, 6 to 9 AM) can suggest the diagnosis of adrenal insufficiency. However, these measurements often cannot definitively establish the presence or absence of adrenal insufficiency. The ACTH stimulation test is the best test to diagnose or exclude adrenal insufficiency when the baseline cortisol value is indeterminate. […] Diagnostic testing should be performed in adults with signs and symptoms of adrenal insufficiency. The symptoms of adrenal insufficiency may be subtle, and the diagnosis of adrenal insufficiency depends upon a critical level of clinical suspicion. […] For patients with suspected chronic adrenal insufficiency, we measure a serum cortisol level within three hours after wakening (eg, 6 to 9 AM). When the clinical suspicion for primary adrenal insufficiency is high, we obtain cortisol, ACTH, renin, and aldosterone levels simultaneously to expedite the diagnosis and determine the etiology. […] A standard high-dose (250 mcg) corticotropin (ACTH) stimulation test should be performed to establish the diagnosis of adrenal insufficiency in patients with indeterminate serum cortisol values in whom hypoadrenalism is suspected.

• #52 How Does Adrenal Insufficiency Diagnosis Work?

  https://www.healthline.com/health/kidney-health/adrenal-insufficiency-diagnosis

  If your primary doctor suspects adrenal insufficiency, youll need to see an endocrinologist to begin the diagnosis process. […] Getting a diagnosis is the first step toward starting a treatment plan that works for you. […] If your primary care doctor suspects you have adrenal insufficiency, they will likely suggest that you see an endocrinologist. […] Endocrinologists specialize in conditions that affect your hormones. They can diagnose adrenal insufficiency and manage your care. […] An endocrinologist will begin by reviewing your symptoms and your medical history. In the early stages of adrenal insufficiency, symptoms often come and go and progress slowly. This can make diagnosis difficult. […] Testing can help confirm the diagnosis and might include: […] Diagnosing adrenal insufficiency often involves multiple tests, so its important to wait for a healthcare professional to interpret your results.

• #53 Addison’s Disease: New Guideline Details Diagnosis and Treatment – Endocrinology Advisor

  https://www.endocrinologyadvisor.com/features/addisons-disease-new-guideline-details-diagnosis-and-treatment/

  The first-ever guideline from Endocrine Society on Addison’s disease details specifics of diagnostic tests and glucocorticoid therapy. […] The guideline includes recommendations in 5 areas: […] Optimal diagnostic tests; […] The diagnostic tests recommended in the guideline include determination of serum cortisol and plasma ACTH for screening and the corticotropin stimulation test as a confirmatory test. […] The task force recommends the standard-dose (250 mcg for adults and children 2 years of age and older, 15 mcg/kg for infants, and 125 mcg for children younger than 2) IV corticotropin stimulation (30- or 60-minute) test over other existing diagnostic tests. […] Patients presenting with severe adrenal insufficiency symptoms or adrenal crisis should receive immediate therapy with IV hydrocortisone in advance of receiving results from diagnostic testing, the recommendations state.

• #54 Addison’s disease differential diagnosis – wikidoc

  https://www.wikidoc.org/index.php/Addison%27s_disease_differential_diagnosis

  Addison’s disease must be differentiated from other diseases that cause hypotension, skin pigmentation, and abdominal pain such as myopathies, celiac disease, Peutz-Jeghers syndrome, anorexia nervosa, syndrome of inappropriate antidiuretic hormone (SIADH), neurofibromatosis, porphyria cutanea tarda, salt-depletion nephritis and bronchogenic carcinoma. […] Addison’s disease (primary adrenal insufficiency) must be first differentiated from secondary and tertiary adrenal insufficiency as all the three of them present with similar symptoms due to cortisol and mineralocorticoid hormone deficiencies. […] Serum ACTH level can help distinguish primary from secondary/tertiary adrenal insufficiency. […] Addison’s disease should be differentiated from other diseases causing secondary adrenal insufficiency due to hypopituitarism. […] Primary adrenal insufficiency/Addison’s disease […] Serum cortisol testing […] Serum ACTH testing […] Anti-adrenal Ab testing.

• #55 Addison’s disease differential diagnosis – wikidoc

  https://www.wikidoc.org/index.php/Addison%27s_disease_differential_diagnosis

  Addison’s disease must be differentiated from other diseases that cause hypotension, skin pigmentation, and abdominal pain such as myopathies, celiac disease, Peutz-Jeghers syndrome, anorexia nervosa, syndrome of inappropriate antidiuretic hormone (SIADH), neurofibromatosis, porphyria cutanea tarda, salt-depletion nephritis and bronchogenic carcinoma. […] Addison’s disease (primary adrenal insufficiency) must be first differentiated from secondary and tertiary adrenal insufficiency as all the three of them present with similar symptoms due to cortisol and mineralocorticoid hormone deficiencies. […] Serum ACTH level can help distinguish primary from secondary/tertiary adrenal insufficiency. […] Addison’s disease should be differentiated from other diseases causing secondary adrenal insufficiency due to hypopituitarism. […] Primary adrenal insufficiency/Addison’s disease […] Serum cortisol testing […] Serum ACTH testing […] Anti-adrenal Ab testing.

• #56 Addison’s disease differential diagnosis – wikidoc

  https://www.wikidoc.org/index.php/Addison%27s_disease_differential_diagnosis

  Addison’s disease must be differentiated from other diseases that cause hypotension, skin pigmentation, and abdominal pain such as myopathies, celiac disease, Peutz-Jeghers syndrome, anorexia nervosa, syndrome of inappropriate antidiuretic hormone (SIADH), neurofibromatosis, porphyria cutanea tarda, salt-depletion nephritis and bronchogenic carcinoma. […] Addison’s disease (primary adrenal insufficiency) must be first differentiated from secondary and tertiary adrenal insufficiency as all the three of them present with similar symptoms due to cortisol and mineralocorticoid hormone deficiencies. […] Serum ACTH level can help distinguish primary from secondary/tertiary adrenal insufficiency. […] Addison’s disease should be differentiated from other diseases causing secondary adrenal insufficiency due to hypopituitarism. […] Primary adrenal insufficiency/Addison’s disease […] Serum cortisol testing […] Serum ACTH testing […] Anti-adrenal Ab testing.

• #57 Addison disease Diagnosis and initial management

  https://www.racgp.org.au/afp/2010/november/addison-disease

  Early recognition of adrenal insufficiency is essential to avoid associated morbidity and mortality. Initial diagnosis and decision to treat are based on history and physical examination. Appropriate management includes emergency resuscitation and steroid administration. Initial investigations can include sodium, potassium and blood glucose levels. However, complete investigations can be deferred. […] Specialist advice should be obtained and long term management includes a Team Care Arrangement. For patients, an emergency plan and emergency identification are essential.

• #58

  https://www.nhs.uk/conditions/addisons-disease/diagnosis/

  To help diagnose Addison’s disease, a GP will first ask about your symptoms and review your medical history. […] If Addison’s disease is suspected, blood tests will be carried out to measure the levels of sodium, potassium and cortisol in your body. A low sodium, high potassium or low cortisol level may indicate Addison’s disease. […] If cortisol in your blood is low or your symptoms strongly suggest Addison’s disease, you’ll need to have a synacthen stimulation test to confirm the diagnosis. […] If the ACTH level is high but the cortisol and aldosterone levels are low, it’s usually confirmation of Addison’s disease. […] If Addison’s disease is left untreated, it eventually leads to an adrenal crisis. This is where the symptoms of Addison’s disease appear quickly and severely. […] During an adrenal crisis, there’s not enough time to perform a synacthen stimulation test to confirm Addison’s disease.

• #59

  https://www2.hse.ie/conditions/addisons-disease/diagnosis/

  To help diagnose Addisons disease, your GP will first ask about your symptoms and review your medical history. […] If Addisons disease is suspected, blood tests will be carried out. These are to measure the levels of sodium, potassium and cortisol in your body. A low sodium, high potassium or low cortisol level may indicate Addisons disease. […] You may need to have a synacthen stimulation test to confirm a diagnosis of Addison’s disease. This is done if cortisol in your blood is low, or your symptoms strongly suggest Addisons disease. […] If the ACTH level is high, but the cortisol and aldosterone levels are low, it’s usually confirmation of Addisons disease. […] If Addisons disease is left untreated, it eventually leads to an adrenal crisis. This is where the symptoms of Addisons disease appear quickly and severely.

• #60

  https://link.springer.com/article/10.1007/s40618-019-01079-6

  Addisons disease (AD) is a rare disorder and among adult population in developed countries is most commonly caused by autoimmunity. […] This review describes epidemiology, pathogenesis, genetics, natural history, clinical manifestations, immunological markers and diagnostic strategies in patients with AD. […] Progress in optimizing replacement therapy for patients with AD has allowed the patients to lead a normal life. […] However, continuous education of patients and health care professionals of ever-present danger of adrenal crisis is essential to save lives of patients with AD. […] The natural history of autoimmune Addisons disease from the detection of autoantibodies to development of the disease: a long-term follow-up study on 143 patients. […] The cortisol stress response induced by surgery: a systematic review and meta-analysis.

• #61 Addison’s disease: a diagnosis not to be missed | Endocrinology Today

  https://endocrinology.medicinetoday.com.au/et/2015/february/feature-article/addisons-disease-diagnosis-not-be-missed

  Addisons disease is a potentially life-threatening disorder caused by deficiencies of all adrenocortical hormones. A high index of suspicion is needed because the presentation is often nonspecific and can mimic other medical and psychiatric conditions. Prompt recognition and treatment is essential and life saving. […] Addisons disease should be suspected in patients presenting with hyperpigmentation of skin and oral mucosa, unexplained weight loss, persistent hyponatraemia or other autoimmune diseases associated with polyendocrinopathy syndrome. […] The initial test in patients with suspected Addisons disease is the measurement of basal morning plasma cortisol and adrenocorticotrophic hormone (ACTH) levels. A basal morning plasma cortisol level of less than 100 mmol/L is diagnostic of adrenal insufficiency. Plasma ACTH levels are elevated in patients with Addisons disease.

• #62 Addison’s disease – Symptoms and causes – Mayo Clinic

  https://www.mayoclinic.org/diseases-conditions/addisons-disease/symptoms-causes/syc-20350293

  Addison’s disease can affect anyone. Without treatment, it can be life-threatening. Treatment involves taking lab-made hormones to replace those that are missing. […] See a healthcare professional if you have common symptoms of Addison’s disease, such as: Long-lasting fatigue. Muscle weakness. Loss of appetite. Darkened areas of skin. Weight loss that doesn’t happen on purpose. Serious upset stomach, vomiting or stomach pain. Lightheadedness or fainting with standing. Salt cravings. […] Get emergency care right away if you have any symptoms of an adrenal crisis.

• #63 Addison Disease – StatPearls – NCBI Bookshelf

  https://www.ncbi.nlm.nih.gov/books/NBK441994/

  Addison disease usually manifests as an insidious and gradual onset of nonspecific symptoms, often resulting in a delayed diagnosis. […] A high clinical suspicion should be maintained to avoid misdiagnosis. […] In many cases, the diagnosis is made only after the patient presents with an acute adrenal crisis manifesting with hypotension, hyponatremia, hyperkalemia, and hypoglycemia. […] The diagnosis is established by demonstrating low cortisol and aldosterone levels, high renin levels, and a blunt cortisol response with ACTH stimulation. […] The diagnosis of Addison disease is established by demonstrating low cortisol and aldosterone levels, high renin levels, and a blunt cortisol response with ACTH stimulation. […] A low random cortisol level is characteristically seen with Addison disease.

• #64 Addison Disease – Endocrine and Metabolic Disorders – Merck Manual Professional Edition

  https://www.merckmanuals.com/professional/endocrine-and-metabolic-disorders/adrenal-disorders/addison-disease

  Diagnosis is clinical and by finding elevated plasma adrenocorticotropic hormone (ACTH) with low plasma cortisol. […] Clinical symptoms and signs suggest adrenal insufficiency. Sometimes the diagnosis is considered only on discovery of characteristic abnormalities of serum electrolytes, including low sodium, high potassium, low bicarbonate, and high BUN (blood urea nitrogen). […] Laboratory tests, beginning with morning serum cortisol and plasma ACTH levels, confirm adrenal insufficiency. Elevated ACTH ( 50 pg/mL [ 11 pmol/L]) with low cortisol ( 5 mcg/dL [ 138 nmol/L]) is diagnostic, particularly in patients who are severely stressed or in shock. […] Addison disease is diagnosed by showing failure of exogenous ACTH to increase serum cortisol. […] If ACTH and cortisol levels are borderline and adrenal insufficiency is clinically suspected particularly in a patient who is about to undergo major surgery provocative testing must be done. […] Elevated ACTH levels together with low cortisol levels confirm the diagnosis.

• #65 Addison Disease | Treatment & Management | Point of Care

  https://www.statpearls.com/point-of-care/17183

  Addison disease usually manifests as an insidious and gradual onset of nonspecific symptoms, often resulting in a delayed diagnosis. […] A high clinical suspicion should be maintained to avoid misdiagnosis. […] In many cases, the diagnosis is made only after the patient presents with an acute adrenal crisis manifesting with hypotension, hyponatremia, hyperkalemia, and hypoglycemia. The diagnosis is established by demonstrating low cortisol and aldosterone levels, high renin levels, and a blunt cortisol response with ACTH stimulation. […] The diagnosis of Addison disease is established by demonstrating low cortisol and aldosterone levels, high renin levels, and a blunt cortisol response with ACTH stimulation. […] A low random cortisol level is characteristically seen with Addison disease.

• #66 Addison Disease Workup: Laboratory Studies, Imaging Studies, Other Tests

  https://emedicine.medscape.com/article/116467-workup

  A quick review of the clinical presentation, physical examination findings, and laboratory findings (when available) quickly heightens the index of suspicion and possibly leads to more appropriate tests and diagnosis. A high index of suspicion is necessary for diagnosis. […] The diagnosis of adrenocortical insufficiency rests on the assessment of the functional capacity of the adrenal cortex to synthesize cortisol. This is accomplished primarily by use of the rapid ACTH stimulation test (Cortrosyn, cosyntropin, or Synacthen). […] An increase in the plasma cortisol and aldosterone levels above basal levels after ACTH injection reflects the functional integrity of the adrenal cortex. […] Two criteria are necessary for diagnosis: (1) an increase in the baseline cortisol value of 7 mcg/dL or more and (2) the value must rise to 20 mcg/dL or more in 30 or 60 minutes, establishing normal adrenal glucocorticoid function.

• #67 Addison’s Disease: New Guideline Details Diagnosis and Treatment – Endocrinology Advisor

  https://www.endocrinologyadvisor.com/features/addisons-disease-new-guideline-details-diagnosis-and-treatment/

  The guideline advises that the etiology of the disease be determined in all patients with confirmed primary adrenal insufficiency. […] The most important takeaway in the guideline is that diagnosis and treatment of primary adrenal insufficiency requires extensive experience and involvement of a specialist, stated Dr Barthel.

• #68

  https://www.addisonsdisease.org.uk/newly-diagnosed

  Newly diagnosed with Addison’s disease or adrenal insufficiency? […] It’s important to learn as much as you can about the condition – this knowledge is likely to make you feel more confident, and it may save your life. […] Diagnosis can stir a range of emotions from relief to fear. […] A round 8% of people with Addison’s disease experience an adrenal crisis each year; some people more frequently than others. […] It’s vitally important that you learn the signs of an impending crisis and what to do in this medical emergency, and to share your knowledge with those closest to you. […] As Addisons is a rare condition, your GP may never have treated a patient with this before. […] The Addisons Disease Self-Help Group is the support group for people with Addisons disease or adrenal insufficiency and their families in the UK and Ireland.

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