|Signs and symptoms
- The slowly progressive loss of cortisol and aldosterone secretion usually produces a chronic, steadily worsening fatigue, a loss of appetite, and some weight loss.
- Blood pressure is low and falls further when a person is standing, producing light-headedness.
- Nausea, sometimes with vomiting, and diarrhoea are common.
- The muscles are weak and often go into spasm.
- There are often emotional changes, particularly irritability and depression.
- Because of salt loss, a craving for salty foods is common.
- Finally, the increase in ACTH due to the loss of cortisol will usually produce a darkening of the skin that may look like an inappropriate tan on a person who feels very sick.
Unfortunately, the slowly progressive chronic symptoms are usually missed or ignored until a sudden event like a flu virus, an accident, or the need for surgery suddenly precipitates a dramatic change for the worse because of the deficient response from the adrenals to one of these stresses. This is referred to as an Addisonian crisis and is a medical emergency.
- 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