Doctors diagnose Addison’s disease by considering signs and symptoms, asking about family history, and through medical tests.
The symptoms of Addison’s disease, also known as primary adrenal insufficiency, are often nonspecific. In other words, they overlap with symptoms of other conditions. This can make diagnosis a challenge.
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
In this article, we will explore the most common methods of diagnosis and explain how they work.
A diagnosis of Addison’s disease may occur when a person sees their doctor about symptoms. However, the person may find out by chance, when a routine blood test reveals unusual levels of sodium or potassium in the blood.
A doctor will take several steps to diagnose Addison’s disease.
The doctor may start by considering any signs and symptoms. A person with Addison’s disease may have:
- fatigue or weakness
- nausea and vomiting
- abdominal pain
- constipation or diarrhea
- muscle cramps
- joint pain
- increased thirst
- craving salty foods
- reduced sex drive
- behavior and mood changes
- low blood pressure
- frequent urination, leading to dehydration
- back pain
- sleep disruption, which may lead to memory problems
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
These changes usually happen gradually, but sometimes they can appear suddenly. If this happens, the person has acute adrenal failure. This is a medical emergency.
A doctor will take the person’s blood pressure. People with Addison’s disease often have low blood pressure.
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 tests can help identify whether Addison’s or another disease is affecting hormone levels.
ACTH stimulation test
The pituitary gland produces ACTH, which encourages the adrenal glands to secrete cortisol and aldosterone.
Cosyntropin is a synthetic version of ACTH. Its trade names include Cortrosyn and Synacthen.
When the doctor gives the person cosyntropin, the adrenal glands should release cortisol into the blood. The tests will show blood levels of cortisol and ACTH.
The ACTH stimulation test will involve several blood tests. There will be one test before the doctor gives cosyntropin and other tests after 30 minutes and 60 minutes. The doctor will check how the body responds.
If ACTH levels are high, and cortisol levels are low, the doctor will likely diagnose Addison’s disease.
Thyroid function test
Blood tests can show if a person has a problem with their thyroid gland, which produces hormones for growth and metabolism.
An underactive thyroid can affect a person’s hormone levels and may increase the risk of developing other autoimmune conditions.
Addison’s disease usually happens when the immune system mistakenly starts to attack a person’s adrenal gland.
Testing for antibodies may help confirm an Addison’s diagnosis.
A CT scan can produce detailed images of the inside of the body, including the internal organs.
The doctor may wish to scan the abdomen to check the size of the adrenal glands and whether any unusual features are present.
They may also investigate the pituitary gland, as problems in this gland can lead to secondary adrenal insufficiency.
Other health conditions
People with the following conditions or concerns may be more likely to develop Addison’s disease, according to the National Institutes of Health (NIH):
- repeat infections
- fungal infections
- infections that occur with AIDS
- genetic disorders
- tumors and cancer
- certain medications
Other diseases may occur alongside Addison’s disease. Research has not always found a direct link to these, but some may result from Addison’s disease.
In a 2016 case study, doctors diagnosed Addison’s disease as the underlying cause of kidney injury in a 37-year-old male.
In another investigation, involving various African countries, researchers found links with:
Conditions with similar symptoms
The doctor will also need to rule out other conditions that may have similar symptoms. 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.
An Addisonian crisis, also called an adrenal crisis or acute adrenal insufficiency, occurs when symptoms are severe. It can happen suddenly and be life threatening.
It can happen if a person does not have treatment or if they receive treatment but undergo stress. It could result, for example, from an accident or during surgery or a severe illness.
Symptoms of an Addisonian crisis include:
- sudden weakness
- severe pain
- vomiting and diarrhea
- fainting due to low blood pressure
- kidney failure
The person will need immediate medical attention.
The doctor will carry out blood tests and investigate signs and symptoms in the same way, but the person will receive treatment before the results are back.
Addison’s disease is a chronic condition that can have a severe impact on a person’s life.
Getting a diagnosis can be worrying, 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 steps can help a person avoid a crisis and have a normal life expectancy.
Click here to find out about the treatment options for Addison’s disease.