In diagnosing Addison’s disease, your GP will ask you about your symptoms and review your medical history. They are also likely to ask about your family to see if there is any history of autoimmune disorders.
Your GP will examine your skin for any evidence of hyperpigmentation (brownish discolouration of the skin). This will be particularly noticeable where your skin creases on your palm or in your elbow, and also on any scars. However, hyperpigmentation does not occur in all cases of Addison’s disease.
You will also be tested for low blood pressure (hypotension); this will probably be measured while you are sitting down and again shortly after you stand up. This is to see whether you have postural or orthostatic hypotension (low blood pressure when you change position).
If Addison’s disease is suspected, samples of your blood will be tested for the salt levels, sodium and potassium, and the hormone cortisol. A low sodium, a high potassium or a low cortisol level may indicate that you have Addison’s disease.
As well as low cortisol, you may need to see a hospital hormone specialist (endocrinologist) for your blood to be tested for the following:
In some cases, your specialist may refer you for a scan of your adrenal gland, which could be a computerised tomography (CT) scan or a magnetic resonance imaging (MRI).
If cortisol in your blood is low, or your symptoms alone strongly suggest Addison’s disease, you will need to have a synacthen stimulation test to confirm the diagnosis.
Your GP may refer you to an endocrinology unit (a unit that specialises in the study of hormones) for a synacthen stimulation test. How urgently you are referred will depend on how severe your symptoms are.
Synacthen is a synthetic (man-made) copy of the adrenocorticotrophic hormone (ACTH). ACTH is naturally produced by the pituitary gland (a pea-sized gland below the brain) to encourage the adrenal glands to release the hormones cortisol and aldosterone. When synacthen is administered, the adrenal glands should respond in the same way as they would to ACTH, and release cortisol and other steroid hormones into the blood.
A blood sample will be taken and tested for the level of cortisol. Synacthen will then be given by an injection into your arm. After 30 and 60 minutes, a further blood sample will be taken for cortisol measurement.
If the ACTH level is high, but the cortisol and aldosterone levels are low, it is usually confirmation of Addison’s disease.
As well as a synacthen stimulation test, your thyroid gland may also be tested to see if it is working properly. Your thyroid gland is found in your neck. It produces hormones that are released into the bloodstream to control your body's growth and metabolism (the process that turns the food you eat into energy).
People with Addison’s disease often have an underactive thyroid gland (hypothyroidism), where the thyroid gland does not produce enough hormones. By testing the levels of certain hormones in your blood, your endocrinologist (a specialist in hormone conditions) can determine whether you have hypothyroidism.
During an adrenal crisis, your blood pressure will be dangerously low, and your symptoms very severe. In this situation, there is not enough time to perform a synacthen stimulation test to confirm Addison’s disease.
If possible, blood will be taken and tested for any of the signs listed above. While you are waiting for the results, treatment may be started with fluids containing salt and glucose before Addison’s disease is diagnosed.