Addison's disease differential diagnosis: Difference between revisions
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! rowspan="2" |Gold standard test | ! rowspan="2" |Gold standard test | ||
|- | |- | ||
|'''Hypotension''' | |'''[[Hypotension]]''' | ||
|'''Abdominal pain''' | |'''[[Abdominal pain]]''' | ||
|'''Anorexia/''' | |'''[[Anorexia]]/''' | ||
'''weight loss''' | '''[[weight loss]]''' | ||
|'''Muscle weakness''' | |'''[[Muscle weakness]]''' | ||
|'''Hypoglycemia''' | |'''[[Hypoglycemia]]''' | ||
|'''Skin pigmentation''' | |'''[[Skin pigmentation]]''' | ||
|'''Other symptoms''' | |'''Other [[symptoms]]''' | ||
|'''Hyponatremia''' | |'''[[Hyponatremia]]''' | ||
|'''Cortisol levels''' | |'''[[Cortisol level|Cortisol levels]]''' | ||
|'''Other labs''' | |'''Other labs''' | ||
|- | |- | ||
| Line 56: | Line 56: | ||
|Low | |Low | ||
| | | | ||
|ACTH | |[[ACTH stimulation test]] | ||
|- | |- | ||
|Myopathies | |[[Myopathies]] | ||
(polymyositis, | ([[polymyositis]], | ||
hereditary myopathies) | hereditary myopathies) | ||
| Line 67: | Line 67: | ||
| + | | + | ||
| - | | - | ||
|Heliotrope | |Heliotrope rash and | ||
Gottron's sign | Gottron's sign | ||
| | | | ||
* Muscle tenderness | * [[Muscle]] [[tenderness]] | ||
| - | | - | ||
|Normal | |Normal | ||
| - | | - | ||
| | |[[Muscle biopsy]] | ||
|- | |- | ||
|Celiac disease | |[[Celiac disease]] | ||
| - | | - | ||
| + | | + | ||
| Line 83: | Line 82: | ||
| - | | - | ||
| - | | - | ||
|Dermatitis | |[[Dermatitis herpetiformis]] | ||
| | | | ||
* Greasy stools | * [[Greasy stools]] | ||
* Increased fecal fat | * Increased [[fecal fat]] | ||
| - | | - | ||
|Normal | |Normal | ||
| - | | - | ||
|Abnormal small bowel biopsy | |Abnormal [[small bowel]] [[biopsy]] | ||
|- | |- | ||
|Syndrome of inappropriate anti-diuretic hormone | |[[Syndrome of inappropriate antidiuretic hormone|Syndrome of inappropriate anti-diuretic hormone]] | ||
(SIADH) | [[Syndrome of inappropriate antidiuretic hormone|(SIADH)]] | ||
| - | | - | ||
|_ | |_ | ||
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|Normal | |Normal | ||
| | | | ||
* Decreased osmolality | * Decreased [[osmolality]] | ||
* Euvolemia | * Euvolemia | ||
* Sodium in urine typically >20 mEq/L | * [[Sodium]] in [[urine]] typically >20 mEq/L | ||
|Water deprivation test | |Water deprivation test | ||
|- | |- | ||
|Neurofibromatosis | |[[Neurofibromatosis]] | ||
| - | | - | ||
| - | | - | ||
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|Axillary- and inguinal-area freckling | |Axillary- and inguinal-area freckling | ||
| | | | ||
* Occasional development of peripheral sarcomas | * Occasional development of peripheral [[sarcomas]] | ||
* May have overgrowth of subcutaneous tissues | * May have overgrowth of [[Subcutaneous tissue|subcutaneous tissues]] | ||
| - | | - | ||
| - | | - | ||
| - | | - | ||
|Biopsy of skin tissue | |[[Skin biopsy|Biopsy of skin tissue]] | ||
|- | |- | ||
|Peutz-Jeghers syndrome | |[[Peutz-Jeghers syndrome]] | ||
| | | | ||
| + | | + | ||
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| + | | + | ||
| | | | ||
* Melanotic hyperpigmentation of the skin and mucous membranes | * Melanotic [[hyperpigmentation]] of the [[skin]] and [[mucous membranes]] | ||
| - | | - | ||
|Normal | |Normal | ||
| | | | ||
|Colonic imaging showing the small intestinal polyps | |Colonic [[imaging]] showing the [[Small intestine|small intestinal]] [[polyps]] | ||
|- | |- | ||
|Porphyria cutanea tarda | |[[Porphyria cutanea tarda]] | ||
| - | | - | ||
| + | | + | ||
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| - | | - | ||
| - | | - | ||
|Blisters on sun-exposed sites | |[[Blisters]] on sun-exposed sites | ||
| | | | ||
* Associated liver disease (usually hepatitis C) | * Associated [[liver disease]] (usually [[hepatitis C]]) | ||
* Hypertrichosis | * [[Hypertrichosis]] | ||
| - | | - | ||
|Normal or elevated | |Normal or elevated | ||
|High level of porphyrins in the urine | |High level of [[porphyrins]] in the [[urine]] | ||
| | | | ||
|- | |- | ||
|Salt-depletion nephritis | |Salt-depletion [[nephritis]] | ||
| + | | + | ||
|Flank pain | |[[Flank pain]] | ||
| - | | - | ||
| - | | - | ||
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| - | | - | ||
| | | | ||
* Fever | * [[Fever]] | ||
* Dysuria | * [[Dysuria]] | ||
* Pyuria | * [[Pyuria]] | ||
* Oliguria | * [[Oliguria]] | ||
| + | | + | ||
|Elevated | |Elevated | ||
|<15:1 BUN:CR | |<15:1 [[BUN-to-creatinine ratio|BUN:CR]] | ||
| | | | ||
|- | |- | ||
|Bronchogenic carcinoma | |[[Bronchogenic carcinoma]] | ||
| - | | - | ||
| - | | - | ||
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| + | | + | ||
| | | | ||
* Cough | * [[Cough]] | ||
* Dyspnea | * [[Dyspnea]] | ||
* Hemoptysis | * [[Hemoptysis]] | ||
| - | | - | ||
|Elevated | |Elevated | ||
|Increased ACTH | |Increased [[ACTH]] and | ||
Hypokalemia | [[Hypokalemia]] | ||
|Cytological or histological evidence of lung cancer in sputum, pleural fluid, or tissue | |[[Cytological]] or [[histological]] [[evidence]] of [[lung cancer]] in [[sputum]], [[pleural fluid]], or tissue | ||
|- | |- | ||
|Anorexia nervosa | |[[Anorexia nervosa]] | ||
| + | | + | ||
| - | | - | ||
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| - | | - | ||
| | | | ||
* Distorted body image | * Distorted [[body image]] | ||
* Oligomenorrhea | * [[Oligomenorrhea]] | ||
| - | | - | ||
|Elevated | |Elevated | ||
| - | | - | ||
|Psychiatric condition | |[[Psychiatric]] condition | ||
|} | |} | ||
Revision as of 14:16, 22 August 2017
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Addison's disease differential diagnosis On the Web |
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Risk calculators and risk factors for Addison's disease differential diagnosis |
Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1] ; Associate Editor(s)-in-Chief: Aditya Ganti M.B.B.S. [2]
Overview
Addison's disease must be differentiated from other diseases that cause hypotension, skin pigmentation, and abdominal pain such as myopathies, celiac disease, Peutz-Jeghers syndrome ,anorexia nervosa, syndrome of inappropriate anti-diuretic hormone (SIADH), neurofibromatosis, porphyria cutanea tarda, salt-depletion nephritis and bronchogenic carcinoma.
Differentiating Addison's disease from other Diseases
Addison's disease (primary adrenal insufficiency) must be first differentiated from secondary and tertiary adrenal insufficiency as all the three of them present with similar symptoms due to cortisol and mineralocorticoid hormone deficiencies.
- Serum ACTH level can help distinguish primary from secondary/tertiary adrenal insufficiency
| Type of
Adrenal insufficiency |
Skin Pigmentation | ACTH | Normal ACTH |
|---|---|---|---|
| Addison disease | + | >60 ng/mL | 5-30 ng/mL |
| Secondary /
tertiary adrenal insufficiency |
- | <5 ng/mL |
Addison's disease must be differentiated from other diseases that cause hypotension, skin pigmentation, and abdominal pain such as myopathies, celiac disease, Peutz-Jeghers syndrome ,anorexia nervosa, syndrome of inappropriate anti-diuretic hormone (SIADH), neurofibromatosis, porphyria cutanea tarda, salt-depletion nephritis and bronchogenic carcinoma.
| Disease | Differentiating symptoms | Differentiating laboratory findings | Gold standard test | ||||||||
|---|---|---|---|---|---|---|---|---|---|---|---|
| Hypotension | Abdominal pain | Anorexia/ | Muscle weakness | Hypoglycemia | Skin pigmentation | Other symptoms | Hyponatremia | Cortisol levels | Other labs | ||
| Addison's disease | + | + | + | + | + | + | - | Low | ACTH stimulation test | ||
| Myopathies
hereditary myopathies) |
- | - | - | + | - | Heliotrope rash and
Gottron's sign |
- | Normal | - | Muscle biopsy | |
| Celiac disease | - | + | + | - | - | Dermatitis herpetiformis |
|
- | Normal | - | Abnormal small bowel biopsy |
| Syndrome of inappropriate anti-diuretic hormone | - | _ | - | - | - | - | - | + | Normal |
|
Water deprivation test |
| Neurofibromatosis | - | - | + | + | - | Axillary- and inguinal-area freckling |
|
- | - | - | Biopsy of skin tissue |
| Peutz-Jeghers syndrome | + | + |
|
- | Normal | Colonic imaging showing the small intestinal polyps | |||||
| Porphyria cutanea tarda | - | + | - | - | - | Blisters on sun-exposed sites |
|
- | Normal or elevated | High level of porphyrins in the urine | |
| Salt-depletion nephritis | + | Flank pain | - | - | - | - | + | Elevated | <15:1 BUN:CR | ||
| Bronchogenic carcinoma | - | - | + | - | - | + | - | Elevated | Increased ACTH and | Cytological or histological evidence of lung cancer in sputum, pleural fluid, or tissue | |
| Anorexia nervosa | + | - | + | + | + | - |
|
- | Elevated | - | Psychiatric condition |