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Addison's Disease Message Board


Addison's Disease Board Index


Hi Sherry, Sorry you are having so many symptoms. Some of it sounds like addisons & some like thyroid. Here is some info on testing for addisons.

[COLOR=DarkRed]Diagnostic Testing for Addison's Disease[/COLOR]


TEST 1: Electrolyte profile:

OBJECT: To determine if the patient exhibits a normal serum (blood) sodium and potassium levels.

THE TEST: A blood draw followed by automated determination of sodium and potassium levels as well as other standard blood markers.

NORMAL RESULT (will vary somewhat from lab to lab): Sodium 135-150 mEq/L; Potassium 3.5-5.2 mEq/L

PRIMARY ADDISONIAN: Will show significantly below normal values of sodium and a elevated (above normal) levels of potassium.

REASON FOR ABNORMALITY: Low or no production of aldosterone from the adrenal cortex. This steroidal hormone regulates our mineral balance and is called a mineralocorticoid. Primary Addisonians lose sodium and retain potassium. Abnormal values here, in additon to physical signs and symptoms, require the next test.


TEST 2: The ACTH stimulation test:

OBJECT: To determine if the patient's adrenal glands can respond to the ACTH message from the pituitary to increase cortisol production in the adrenal cortex.

THE TEST: The test is usually given first thing in the morning when normal cortisol levels are highest. Blood is withdrawn from the patient to establish a baseline (No instructions regarding necessity for fasting). The patient is given 250 micrograms (ug) of ACTH (Cortrosyn, Cosyntropin, or Synacthen) by injection in saline at one time. Blood is drawn at 30 minutes and/or 60 minutes and the serum cortisol level is determined.

NORMAL RESULTS: Normal pre-injection levels of cortisol are 5-25 ug/dL (138-690 nmol/L). The value should double at 30-60 minutes with a minimum of 20 ug/dL (552 nmol/L). PRIMARY ADDISONIAN: There will be no or little increase in cortisol levels upon ACTH injection. Notes: It is stated in several places that a single test of cortisol levels, or even 24 h urinary levels of cortisol and its metabolites, are NOT DIAGNOSTIC! In the normal individual cortisol levels are seen to pulse. Low cortisol production in either the serum or the urine after ACTH stimulation is diagnostic of Addisons disease.

SECONDARY ADDISONIAN (Pituitary malfunction): Low cortisol production can be seen if the patient has "functional adrenal cortical atrophy" due to prolonged absence of normal ACTH secretion. This type of patient would not show the typical hyper-pigmentation of primary Addisons.

REASON FOR ABNORMALITY: Due to autoimmune, or other destruction of enzymatic (biocatalytic) machinery of the adrenal gland, there is no response to ACTH and no production of cortisol and other adrenal steroids necessary for life. If this test gives normal results and the patient has other signs and symptoms then one of the following tests is required.


TEST 3: The insulin stimulation test.

OBJECT: The purpose of this test is to determine whether the patient's pituitary gland can produce ACTH in response to an insulin stimulus. Abnormally high insulin will drive the patient into hypoglycemia and stimulate the production of ACTH from the pituitary. This test is called by Dr. Krasner (JAMA, 1999, 282 671-676) the traditional test to determine the integrity of the messenger pathway between the hypothalamus, pituitary and adrenal gland. He stresses that it should be given by qualified medical personnel under the direct supervision of a physician, because insulin shock can result.

THE TEST: Baseline blood levels are taken. Insulin is injected into the patient until the blood glucose level falls below 2.2 mmol/L (40 mg/dL). Blood is drawn at intervals up to 90 minutes and the serum cortisol is measured. (This is simpler than determining the ACTH level).

NORMAL RESULTS: A normal patient will show an increase of cortisol production (due to increased ACTH production of not less then 550 nmol/L or (20 ug/dL).

DISEASED PATIENT (SECONDARY ADDISONS): If there is no or little increase in cortisol production as measured by several blood draws after this test is given, then, according to Dr. Krasner, the patient has significant hypothalamic-pituitary-adrenal (HPA) axis impairment.

REASON FOR ABNORMALITY: Basically, either the pituitary or the hypothalamus glands are not showing normal physiology. There can be several reasons for this. The pituitary may have lost its ability to make ACTH due to autoimmune impairment. The hypothalamus may not be sending the right signal to pituitary. There may be a pituitary tumor. Finally, the HPA axis may be suppressed due to sustained therapeutic use of steroids like prednisone which is given to those with chronic inflammation of various kinds. Asthmatics sometimes get in this situation.





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