Differentiating Secondary adrenal insufficiency from other diseases
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Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]
Overview
[Disease name] must be differentiated from other diseases that cause [clinical feature 1], [clinical feature 2], and [clinical feature 3], such as [differential dx1], [differential dx2], and [differential dx3].
OR
[Disease name] must be differentiated from [[differential dx1], [differential dx2], and [differential dx3].
Differentiating X from other Diseases
- [Disease name] must be differentiated from other diseases that cause [clinical feature 1], [clinical feature 2], and [clinical feature 3], such as [differential dx1], [differential dx2], and [differential dx3].
- [Disease name] must be differentiated from [[differential dx1], [differential dx2], and [differential dx3].
- As [disease name] manifests in a variety of clinical forms, differentiation must be established in accordance with the particular subtype. [Subtype name 1] must be differentiated from other diseases that cause [clinical feature 1], such as [differential dx1] and [differential dx2]. In contrast, [subtype name 2] must be differentiated from other diseases that cause [clinical feature 2], such as [differential dx3] and [differential dx4].
Preferred Table
| Diseases | Laboratory Findings | Physical Examination | History and Symptoms | Other Findings | |||||||||
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| Lab Test 1 | Lab Test 2 | Lab Test 3 | Lab Test 4 | Physical Finding 1 | Physical Finding 2 | Physical Finding 3 | Physical Finding 4 | Finding 1 | Finding 2 | Finding 3 | Finding 4 | ||
| Differential Diagnosis 1 | + | ||||||||||||
| Differential Diagnosis 2 | ↑ | - | |||||||||||
| Differential Diagnosis 3 | ↓ | ||||||||||||
| Differential Diagnosis 4 | |||||||||||||
| Differential Diagnosis 5 | |||||||||||||
Use if the above table can not be made
| Differential Diagnosis | Similar Features | Differentiating Features |
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| Differential 1 |
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| Differential 2 |
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| Differential 3 |
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| Differential 4 |
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| Differential 5 |
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Differentiating Adrenal Insufficiency from other Diseases
Adrenal insufficiency can be difficult to diagnose in its initial stages. Medical history and symptoms is the cornerstone of diagnosis for the physician and confirmation through hormonal blood tests and urine tests further support preliminary diagnosis. The steps for the diagnosis of adrenal insufficiency allow the health care provider to distinguish between it and other diseases, therefore the steps of diagnosis are critical. Firstly, cortisol levels are determined followed by the establishment of the cause. In order to determine the cause imaging studies of the adrenal and pituitary glands are used. [5] [6] Adrenal insufficiency (Addison disease) may be difficult to differentiate from other conditions if the onset is gradual e.g. chronic fatigue syndrome and depression). [7][8] Physicians should consider in their differential diagnosis of adrenal insufficiency patients with suggestive symptoms, such as chronic fatigue, anorexia, nausea, vomiting, diarrhea, unexplained weight loss, dehydration, hypoglycemia, and hypotension. Physicians caring for patients with other known autoimmune disorders should consider these relevant diagnoses. Other conditions that must be considered include adrenocorticotropic hormone (ACTH) receptor defect, adrenoleukodystrophy and adrenomyeloneuropathy, autoimmune polyglandular endocrinopathy syndromes, infectious adrenalitis e.g. in association with human immunodeficiency [HIV] virus or tuberculosis (TB), adrenal hemorrhage, lipoid adrenal hyperplasia and Wolman disease. Antiphospholipid syndrome occasionally results in acute adrenal insufficiency secondary to bilateral adrenal hemorrhage. [9]
Differential Diagnoses:
• 3-Beta-Hydroxysteroid Dehydrogenase Deficiency • Adrenal Hypoplasia • Birth Trauma • Chronic Fatigue Syndrome (CFS) • Congenital Adrenal Hyperplasia • Familial Glucocorticoid Deficiency • Pediatric Hypopituitarism • Pseudohypoaldosteronism