Addison's disease differential diagnosis: Difference between revisions
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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. | 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. | ||
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{| | |||
|-style="background: #4479BA; color: #FFFFFF; text-align: center;" | |||
! rowspan="2" |Disease | ! rowspan="2" |Disease | ||
! colspan="7" |Differentiating symptoms | ! colspan="7" |Differentiating symptoms | ||
! colspan="3" |Differentiating laboratory findings | ! colspan="3" |Differentiating laboratory findings | ||
! rowspan="2" |Gold standard test | ! rowspan="2" |Gold standard test | ||
|- | |-style="background: #4479BA; color: #FFFFFF; text-align: center;" | ||
|''' | |'''Hypotension''' | ||
|''' | |'''Abdominal pain''' | ||
|''' | |'''Anorexia/''' | ||
''' | '''weight loss''' | ||
|''' | |'''Muscle weakness''' | ||
|''' | |'''Hypoglycemia''' | ||
|''' | |'''Skin pigmentation''' | ||
|'''Other | |'''Other symptoms''' | ||
|''' | |'''Hyponatremia''' | ||
|''' | |'''Cortisol level|Cortisol levels''' | ||
|'''Other labs''' | |'''Other labs''' | ||
|- | |-style="background: #DCDCDC; padding: 5px; text-align: center;" | ||
|Addison's disease | |Addison's disease | ||
| + | | + | ||
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|[[ACTH stimulation test]] | |[[ACTH stimulation test]] | ||
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|[[Myopathies]] | |[[Myopathies]] | ||
([[polymyositis]], | ([[polymyositis]], | ||
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| - | | - | ||
|[[Muscle biopsy]] | |[[Muscle biopsy]] | ||
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|[[Celiac disease]] | |[[Celiac disease]] | ||
| - | | - | ||
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| - | | - | ||
|Abnormal [[small bowel]] [[biopsy]] | |Abnormal [[small bowel]] [[biopsy]] | ||
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|[[Syndrome of inappropriate antidiuretic hormone|Syndrome of inappropriate anti-diuretic hormone]] | |[[Syndrome of inappropriate antidiuretic hormone|Syndrome of inappropriate anti-diuretic hormone]] | ||
[[Syndrome of inappropriate antidiuretic hormone|(SIADH)]] | [[Syndrome of inappropriate antidiuretic hormone|(SIADH)]] | ||
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* [[Sodium]] in [[urine]] typically >20 mEq/L | * [[Sodium]] in [[urine]] typically >20 mEq/L | ||
|Water deprivation test | |Water deprivation test | ||
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|[[Neurofibromatosis]] | |[[Neurofibromatosis]] | ||
| - | | - | ||
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| - | | - | ||
|[[Skin biopsy|Biopsy of skin tissue]] | |[[Skin biopsy|Biopsy of skin tissue]] | ||
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|[[Peutz-Jeghers syndrome]] | |[[Peutz-Jeghers syndrome]] | ||
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|Colonic [[imaging]] showing the [[Small intestine|small intestinal]] [[polyps]] | |Colonic [[imaging]] showing the [[Small intestine|small intestinal]] [[polyps]] | ||
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|[[Porphyria cutanea tarda]] | |[[Porphyria cutanea tarda]] | ||
| - | | - | ||
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|High level of [[porphyrins]] in the [[urine]] | |High level of [[porphyrins]] in the [[urine]] | ||
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|Salt-depletion [[nephritis]] | |Salt-depletion [[nephritis]] | ||
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|<15:1 [[BUN-to-creatinine ratio|BUN:CR]] | |<15:1 [[BUN-to-creatinine ratio|BUN:CR]] | ||
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|[[Bronchogenic carcinoma]] | |[[Bronchogenic carcinoma]] | ||
| - | | - | ||
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[[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 | ||
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|[[Anorexia nervosa]] | |[[Anorexia nervosa]] | ||
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Revision as of 14:37, 22 August 2017
Addison's disease Microchapters |
Diagnosis |
---|
Treatment |
Case Studies |
Addison's disease differential diagnosis On the Web |
American Roentgen Ray Society Images of Addison's disease differential diagnosis |
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/
weight loss |
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 |