Diagnosis of Addison's Disease
Diagnostic Test list for Addison's Disease:
The list of medical tests
mentioned in various sources as
used in the diagnosis of Addison's Disease
includes:
Addison's Disease Diagnosis: Book Excerpts
Tests and diagnosis discussion for Addison's Disease:
A diagnosis of Addison's disease is made by biochemical laboratory
tests. The aim of these tests is first to determine whether there are
insufficient levels of cortisol and then to establish the cause. X-ray
exams of the adrenal and pituitary glands also are useful in helping to
establish the cause.
ACTH Stimulation Test
This is the most specific test for diagnosing
Addison's disease. In this test, blood and/or urine cortisol levels are
measured before and after a synthetic form of ACTH is given by injection.
In the so called short, or rapid, ACTH test, cortisol measurement in blood
is repeated 30 to 60 minutes after an intravenous ACTH injection. The
normal response after an injection of ACTH is a rise in blood and urine
cortisol levels. Patients with either form of adrenal insufficiency
respond poorly or do not respond at all.
When the response to the short ACTH test is abnormal, a "long" ACTH
stimulation test is required to determine the cause of adrenal
insufficiency. In this test, synthetic ACTH is injected either
intravenously or intramuscularly over a 48- to 72-hour period, and blood
and/or urine cortisol are measured the day before and during the 2 to 3
days of the injection. Patients with primary adrenal insufficiency do not
produce cortisol during the 48- to 72-hour period; however, patients with
secondary adrenal insufficiency have adequate responses to the test on the
second or third day.
In patients suspected of having an addisonian crisis, the doctor must
begin treatment with injections of salt, fluids, and glucocorticoid
hormones immediately. Although a reliable diagnosis is not possible while
the patient is being treated, measurement of blood ACTH and cortisol
during the crisis and before glucocorticoids are given is sufficient to
make the diagnosis. Once the crisis is controlled and medication has been
stopped, the doctor will delay further testing for up to 1 month to obtain
an accurate diagnosis.
Insulin-Induced Hypoglycemia Test
A reliable test to determine how the
hypothalamus and pituitary and adrenal glands respond to stress is the
insulin-induced hypoglycemia test. In this test, blood is drawn to measure
the blood glucose and cortisol levels, followed by an injection of
fast-acting insulin. Blood glucose and cortisol levels are measured again
at 30, 45, and 90 minutes after the insulin injection. The normal response
is for blood glucose levels to fall and cortisol levels to rise.
Other Tests
Once a diagnosis of primary adrenal
insufficiency has been made, x-ray exams of the abdomen may be taken to
see if the adrenals have any signs of calcium deposits. Calcium deposits
may indicate TB. A tuberculin skin test also may be used.
If secondary adrenal insufficiency is the cause, doctors may use
different imaging tools to reveal the size and shape of the pituitary
gland. The most common is the CT scan, which produces a series of x-ray
pictures giving a cross-sectional image of a body part. The function of
the pituitary and its ability to produce other hormones also are tested.
(Source: excerpt from Addison's Disease: NIDDK)
Diagnostic Tests for Addison's Disease: Online Medical Books
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Adrenal hypofunction:
Diagnosis
(Professional Guide to Diseases (Eighth Edition))
Diagnosis requires demonstration of decreased corticosteroid concentrations in plasma and an accurate classification of adrenal hypofunction as primary or secondary. If secondary adrenal hypofunction is suspected, the metyrapone test is indicated. This test requires oral or I.V. administration of metyrapone, which blocks cortisol production and should stimulate the release of corticotropin from the hypothalamic-pituitary system. In adrenal hypofunction, the hypothalamic-pituitary system responds normally, and plasma reveals high levels of corticotropin; however, plasma levels of cortisol precursor and urinary concentrations of 17-hydroxycorticosteroids don’t rise.
If either primary or secondary adrenal hypofunction is suspected, a short corticotropin stimulation test may be done. If both corticotropin and cortisol are low, the long corticotropin test may be done. The test involves I.V. administration of corticotropin over 6 to 8 hours, after samples have been obtained to determine baseline plasma cortisol and 24-hour urine cortisol levels. In adrenal hypofunction, plasma and urine cortisol levels fail to rise normally in response to corticotropin; in secondary hypofunction, repeated doses of corticotropin over successive days produce a gradual increase in cortisol levels until normal values are reached.
In a patient with typical addisonian symptoms, the following laboratory findings strongly suggest acute adrenal hypofunction:
❑ decreased cortisol levels in plasma (less than 10 mcg/dl in the morning, with lower levels in the evening); however, this test is time-consuming, and emergency therapy shouldn’t be postponed for test results
❑ decreased serum sodium and fasting blood glucose levels
❑ increased serum potassium and blood urea nitrogen levels
❑ elevated hematocrit and lymphocyte and eosinophil counts
❑ X-rays showing a small heart and adrenal calcification.
» READ BOOK EXCERPT ONLINE »
Source: Professional Guide to Diseases (Eighth Edition), 2005
Adrenal hypofunction:
Diagnosis
(Handbook of Diseases)
The diagnosis of adrenal insufficiency should be made only with corticotropin stimulation testing to assess adrenal reserve capacity.
The corticotropin stimulation test involves I.M. or I.V. administration of cosyntropin with samples obtained 60 minutes later. Cortisol levels should be greater than 18 µg/dl. If the result is abnormal, primary and secondary adrenal insufficiency can be distinguished by measuring aldosterone levels from the same blood sample. With secondary adrenal insufficiency, the aldosterone level is normal (greater than or equal to 5 ng/dl). Baseline plasma cortisol levels may also be obtained. With Addison’s disease, plasma and urine cortisol levels fail to rise normally in response to corticotropin; with secondary hypofunction, repeated doses of corticotropin over successive days produce a gradual increase in cortisol levels until normal values are reached.
» READ BOOK EXCERPT ONLINE »
Source: Handbook of Diseases, 2003
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