Addison's disease differential diagnosis

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Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]

Differentiating Addison's disease from other Diseases

Addison's disease should be differentiated from the following diseases:

• Acanthosis nigricans
• Anorexia nervosa
• Chronic fatigue syndrome
• Depression
• Disorders of oral pigmentation
• Hyperthyroidism
• Laugier-Hunziker Syndrome
• Lentigo
• Malignant melanoma
• Melasma
• Occult malignancy
• Oral manifestations of systemic diseases
• Peutz-Jeghers syndrome
• Type 1 diabetes mellitus
• Vitiligo

	Harmone or pathway defective
ACTH deficiency	↓ ACTH	Pituitary gland	unintentional weightloss lack of appetite, weakness, nausea, vomiting, and low blood pressure very little pubic axillary hair in females Normal skin pigenm	Low ACTH level. Pituitary hormone abnormalities: TSH, prolactin, FSH, LH, GH. CT or MRI brain showing lesion in the pituitary gland or hypothalamus.
Congenital adrenal hyperplasia (CAH)	↓ Corticosteroid hormones	Adrenal gland		Masculinized to various degrees. Lack of glucocorticoids, especially cortisol, causes various problems. Lack of mineralocorticoids, primarily aldosterone, causes salt and water imbalances
Adrenoleukodystrophy	ABCD1 gene on the X chromosome	White matter of the nervous system and the adrenal cortex
Autoimmune polyendocrine syndrome type II ( Schmidt syndrome)	↓Parathyroid harmone ↓Insulin ↓Sex harmones	parathyroid gland Pancreas Gonads
Autoimmune polyendocrine syndrome type I, (APS type 1) ( APECED syndrome)	Autoimmune Polyendocrinopathy (APE), Candidiasis (C) and Ectodermal Dysplasia (ED)	Autoimmune Polyendocrinopathy (APE) Candidiasis (C) Ectodermal Dysplasia (ED)
Hemachromatosis
Hyperthyroidism