Routine laboratory investigations may be suggestive of Addison’s disease and include hypoglycemia (severe especially among children due to loss of glucocorticoids glucogenic effects), high blood calcium level, high blood potassium level (due to loss of production of the hormone aldosterone, a cortisol), low blood sodium levels (hyponatremia) etc. In addition there may be increased eosinophils and lymphocytes (both are white blood cells). Increased acidity of blood (metabolic acidosis) is another suggestive laboratory finding in Addison’s disease. Metabolic acidosis is due to lack of aldosterone, which results in loss of sodium in urine and in return retention of hydrogen ions, which increase acidity of body fluid (blood).

If a person is suspected to be suffering from Addison’s disease, it is important to demonstrate low levels of adrenal hormone, despite adequate stimulation of adrenal gland to produce sufficient hormones. The test performed is called “ACTH stimulation” test, performed using synthetic pituitary ACTH hormone tetracosactide, which can be of two types, short test and long test.

Short ACTH stimulation test:

In short ACTH stimulation test, blood cortisol level is compared before giving tetracosactide and one hour after giving 250 microgram tetracosactide, by IV/IM (intravenously or intramuscularly) injection. If plasma cortisol level after one hour rises by at least 330 nmol/Liter to at least 690 nmol/Liter, adrenal failure is excluded. If short ACTH stimulation test is abnormal, the long ACTH stimulation test is performed.

Long ACTH stimulation test:

In the long ACTH stimulation test, 1 mg (1,000 microgram) tetracosactide is injected by intravenously or intramuscularly and blood sample taken at 1, 4, 8 and 24 hours. In normal subject the plasma cortisol level should be at least 1000 nmol/Liter at 4 hours. Less than 1000 nmol/Liter cortisol in blood at 4 hours indicate Addison’s disease.

Other tests, which can be used in diagnosis of Addison’s disease include, medical imaging such as USG (ultrasound), CT (computerized tomography) scan and MRI (magnetic resonance imaging).

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