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How is an Addisonian crisis diagnosed?

In patients suspected of having an Addisonian crisis, health professionals must immediately begin treatment with injections of salt, glucose-containing fluids, and glucocorticoid hormones. Although a reliable diagnosis may not be possible during crisis treatment, the measurement of blood adrenocorticotropic hormone (ACTH) and cortisol during the crisis -- before glucocorticoids are given -- is enough to make a preliminary diagnosis. Low blood sodium, low blood glucose, and high blood potassium are also usually present at the time of an adrenal crisis. Once the crisis is controlled, the ACTH stimulation test can be performed to obtain the specific diagnosis. More complex laboratory tests are sometimes used if the diagnosis remains unclear.

Once a diagnosis of Addison's disease is made, radiologic studies such as an X-ray or ultrasound of the abdomen may be taken to see if the adrenals have any signs of calcium deposits. Calcium deposits may indicate bleeding in the adrenal gland or TB, for which a tuberculin skin test also may be used. Blood tests can detect antibodies associated with autoimmune Addison's disease.

If secondary adrenal insufficiency is diagnosed, doctors may use different imaging tools to reveal the size and shape of the pituitary gland. The most common is a computed tomography (CT) scan, which produces a series of X-ray pictures giving cross-sectional images. A magnetic resonance imaging (MRI) scan may also be used to produce a 3-D image of this region. The function of the pituitary and its ability to produce other hormones are also assessed with blood tests.

This answer is based on source information from the National Institute of Diabetes and Digestive and Kidney Diseases.
 

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