Diagnosing Addison's disease

To help diagnose Addisons disease, your GP will first ask about your symptoms and review your medical history.

They're also likely to ask if anyone in your family hasan autoimmune disorder (a condition caused by a problem with their immune system).

Your GP will examine your skin for any evidence of brownish discolouration (hyperpigmentation), particularly in certain areas, such as:

• where skin creases on your palm
• in your elbow crease
• on any scars
• your lips and gums

However, hyperpigmentation doesn't occur in all cases of Addisons disease.

You'll also be tested for low blood pressure (hypotension) while you're lying 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).

Blood tests

If Addisons disease is suspected, blood tests will be carried out to measure the levels ofsodium, potassium and cortisol in your body. A low sodium, high potassium or low cortisol level may indicateAddisons disease.

You may need to see a hospital hormone specialist (endocrinologist) for your bloodto be tested for the following:

• a low level of the hormone aldosterone
• a high level of adrenocorticotrophic hormone (ACTH)
• a low level of glucose (sugar used for energy)
• positive adrenal antibodies (antibodies designed to attack the adrenal gland)

Any of the above could be a sign of Addisons disease.

Synacthen stimulation test

If cortisolin your bloodislow, or your symptoms strongly suggest Addisons disease, you'll 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 the test. How urgently you're referred depends on how severe your symptoms are.

Synacthen is a man-made (synthetic) 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 andother steroid hormonesinto the blood.

A blood sample will be taken and tested for cortisol, before an injection ofsynacthen is given into your arm. After 30 and 60 minutes, a furtherblood sample will be taken for cortisol measurement.

If the ACTH level is high, but the cortisol and aldosterone levels are low, it's usually confirmation of Addisons disease.

Thyroid function test

As well as a synacthen stimulation test, your thyroid gland may also be tested to see if it's working properly.

Your thyroid gland is found in your neck. It produces hormones that control your body's growth and metabolism.

People with Addisons 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.

Scans

In some cases, yourspecialist may refer you for a scan of your adrenal glands this could be a computerised tomography (CT) scan or a magnetic resonance imaging (MRI) scan .

Diagnosis during an adrenal crisis

If Addisons disease is left untreated, it eventually leads to an adrenal crisis. This is wherethe symptoms of Addisons disease appear quickly and severely.

During an adrenal crisis, there's not enough time to perform a synacthen stimulation test to confirm Addisons disease.

If possible, blood will be taken and tested for any of the abnormalities listed above. While you're waiting for the results, treatment may be started with steroid injections, and fluids containing salt and glucose.

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Driving

If you're diagnosed with Addison's disease andhave a bus, coach or lorry licence, it's your legal obligation to inform the Driver and Vehicle Licensing Agency (DVLA).

Read about driving andAddison's disease on the GOV.UK website.