Addison's disease is a rare disorder where the adrenal glands fail to produce sufficient cortisol and aldosterone hormones. It is caused by damage to the adrenal cortex, most commonly from autoimmune destruction. The Adrenocorticotropic Hormone (ACTH) test is the most important test for diagnosis because it reveals elevated ACTH levels when the pituitary gland attempts to stimulate failing adrenal glands.
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Addison's disease is caused by damage to the adrenal cortex that prevents it from producing enough cortisol and aldosterone hormones. In about 70-90% of cases in developed countries, autoimmune destruction is the primary cause, where your immune system mistakenly attacks and damages your adrenal glands. Other causes include tuberculosis infection, chronic infections like fungal diseases, cancer that spreads to the adrenal glands, bleeding into the adrenal glands, or surgical removal of the adrenal glands.
The Adrenocorticotropic Hormone (ACTH) test is the most important test for Addison's disease because it reveals the characteristic hormone imbalance that occurs with adrenal failure. In Addison's disease, ACTH levels are typically elevated as the pituitary gland tries to stimulate unresponsive adrenal glands to produce more cortisol. This test is usually ordered alongside cortisol level testing to confirm the diagnosis. When ACTH is high but cortisol is low, it indicates primary adrenal insufficiency. Your doctor may also recommend additional tests like an ACTH stimulation test, electrolyte panel to check sodium and potassium levels, or antibody tests to determine if autoimmune disease is the cause.
You should get tested if you experience persistent fatigue and muscle weakness that doesn't improve with rest, unexplained weight loss and decreased appetite, low blood pressure that causes dizziness when standing up, or darkening of your skin in areas like scars, skin folds, or your gums. You should also seek testing if you have salt cravings, nausea, vomiting, or diarrhea that lasts for weeks, or if you experience an Addisonian crisis with severe symptoms like sudden pain in your lower back or legs, severe vomiting and diarrhea leading to dehydration, low blood pressure, or loss of consciousness.
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What this means
Your ACTH levels are elevated above the optimal range, which may indicate your pituitary gland is working harder to stimulate your adrenal glands. This could suggest your adrenal glands aren't producing enough cortisol, potentially contributing to fatigue, low blood pressure, or difficulty handling stress.
Recommended actions
Schedule a follow-up with an endocrinologist to investigate potential adrenal insufficiency
Keep a symptom diary tracking energy levels, salt cravings, and blood pressure readings
Prioritize stress management through adequate sleep and gentle exercise
Consider additional testing like cortisol levels to get a complete picture of adrenal function
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