continued from previous page...

Diagnostic tests

• A medical history of the symptoms mentioned above, especially hyper pigmentation of the skin or gums, is often enough to raise a strong suspicion, prompting the appropriate tests.

• Quite often, however, the first clue is from the abnormal results of routine tests done in a hospital or doctor's office. These may include an elevated blood level of potassium, a low blood level of sodium, a shift in the ratio of certain white blood cells, or surprising changes on an EKG or chest x-ray that are caused by high potassium or low blood volume. Other causes for these changes, particularly from medications, must be considered first.

• A definitive diagnosis of Addison's disease requires that definitive tests be carried out.   The standard test used here is the ACTH stimulation test.

• The ACTH stimulation test is a blood test in which the amount of cortisol in the blood is measured before and after an injection of ACTH, usually over a period of 60 minutes.  Individuals with adrenal disease produce a comparatively small amount of extra cortisol in response to the injection.  Different hospitals apply different thresholds to define how small an increase in blood cortisol means adrenal failure. An elevated blood level of ACTH should also be found.

• If the patient is very sick and Addison's disease is suspected, treatment can be initiated while the diagnostic tests are being done.

• Once the diagnosis of Addison's disease is established, an effort should be made to find the cause by checking for tuberculosis and other infections through skin tests and x-rays.

 Seeking medical help

•  In the UK, you must ask your GP to refer you to an endocrinologist for specialist assessment.

• Kathleen Hilditch has written an account of her experiences in getting diagnosed.  Her story provides an informative picture of the gradual onset of Addison’s symptoms, and of the difficulties in getting medical attention for an endocrine condition which has non-specific symptoms of fatigue and exhaustion as its main components.  Although her diagnosis took place over 40 years ago, her story remains relevant today.  Also read the ADSHG letter in response and other responses.

Our thanks to Paul Margulies, M.D., F.A.C.P., F.A.C.E., Medical Director of the United States National Adrenal Diseases Foundation and Clinical Associate Professor of Medicine, Cornell University Medical College, whose text we have adopted in this section.

Previous Page   Next Page