Addison’s 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.
- Addison’s 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 Addison’s 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 Addison’s disease.
- The short Synacthen test should be performed if basal plasma cortisol levels are nondiagnostic.
- Treatment should not be delayed in patients with suspected adrenal crisis while awaiting diagnostic confirmation.
- Referral of the patient to an endocrinologist is essential in cases of equivocal diagnostic tests with high clinical suspicion of adrenal insufficiency and for long-term management of diagnosed Addison’s disease.
Picture credit: © Bob L. Shepherd/Science Source/Diomedia.com