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Addisonian crisis presenting with a normal short tetracosactrin stimulation test
G P Butcher1, M Zambon, S Moss
1Department of Medicine, Royal Postgraduate Medical School, Hammersmith Hospital, London, UK.
Postgraduate Medical Journal
|June 1, 1992
Summary
A man initially showed symptoms of Addison's disease but had a normal Synacthen test. Later, recurrent symptoms and an abnormal Synacthen test confirmed the diagnosis, highlighting the need for further investigation.
Area of Science:
- Endocrinology
- Internal Medicine
Background:
- Addison's disease, or primary adrenal insufficiency, is characterized by inadequate cortisol production.
- The short tetracosactrin (Synacthen) test is commonly used to assess adrenal reserve.
Observation:
- A 70-year-old male presented with clinical and biochemical signs suggestive of Addison's disease.
- Initial short tetracosactrin testing yielded normal results, not supporting the diagnosis.
Findings:
- The patient re-presented six months later with similar symptoms.
- Repeat tetracosactrin testing demonstrated an abnormal response, confirming the diagnosis of Addison's disease.
- This case underscores the potential for delayed diagnosis in adrenal insufficiency.
Implications:
- A normal Synacthen test does not always exclude Addison's disease, especially with persistent clinical suspicion.
- Further diagnostic evaluation may be warranted if adrenal insufficiency is strongly suspected despite initial negative testing.
- This highlights the importance of serial testing and clinical correlation in diagnosing endocrine disorders.