Addison's disease: Adrenal
When to seek medical advice
If you have severe fatigue, have unintentionally lost weight, feel
progressively weaker, experience abdominal pain, have fainting spells
and your skin has become darker, see your doctor to determine whether
Addison's disease or some other medical condition may be the cause.
Screening and diagnosis
Your doctor will talk to you first about your medical history and your
signs and symptoms. If your doctor thinks that you may have Addison's
disease, you may undergo some of the following tests:
Measuring your blood levels of sodium, potassium, cortisol and ACTH
gives your doctor an initial indication of whether adrenal
insufficiency may be causing your signs and symptoms. A blood test
also can measure antibodies associated with autoimmune Addison's
This test involves measuring the level of cortisol in your blood or
urine before and after an injection of synthetic ACTH. ACTH signals
your adrenal glands to produce cortisol. If your adrenal glands are
damaged, the ACTH stimulation test shows that your output of
cortisol in response to synthetic ACTH is blunted or nonexistent.
Occasionally, doctors suggest this test if pituitary disease is a
possible cause of adrenal insufficiency (secondary adrenal
insufficiency). The test involves checking your blood sugar (blood
glucose) and cortisol levels at various intervals after an injection
of insulin. In healthy people, glucose levels fall and cortisol
Your doctor may have you undergo a computerized tomography (CT) scan
of the abdomen to check the size of your adrenal glands and look for
other abnormalities that may give insight to the cause of the
adrenal insufficiency. Your doctor also may suggest a CT scan or
magnetic resonance imaging scan of your pituitary gland if testing
indicates you have secondary adrenal insufficiency.
If you receive an early diagnosis of Addison's disease, treatment may
involve taking prescription corticosteroids. Because your body isn't
producing sufficient steroid hormones, your doctor may have you take one
or more hormones to replace the deficiency. Cortisol is replaced using
hydrocortisone (Cortef), prednisone (Deltasone) or cortisone.
Fludrocortisone (Florinef) replaces aldosterone, which controls your
body's sodium and potassium needs and keeps your blood pressure normal.
You take these hormones orally in daily doses that mimic the amount your
body normally would make, thereby minimizing side effects. If you're
facing a stressful situation such as an operation, an infection or a
minor illness, your doctor may suggest a temporary increase in your
dosages. If you're ill with vomiting and can't retain oral medications,
you may need corticosteroid injections.
An addisonian crisis is a life-threatening situation that results in low
blood pressure, low blood levels of sugar and high blood levels of
potassium. This situation requires immediate medical care. Treatment
typically includes intravenous injections of:
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