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March 22, 2003

Other Illnesses

Question from Batesville, Indiana, USA:

My teenage son, who has type�1 diabetes with an hemoglobin A1c below 6%, recently tried a new, young endocrinologist, who suggested we bring our son back the next week to test for Addison's disease by injecting a substance into our son's back and then taking three blood draws to measure cortisol levels. We did not allow the doctor to do this test since our son seems to be doing fine. What is Addison's disease? What are its symptoms? Is this a routine test given to people with type 1 diabetes? It was never brought up on previous visits to another center.

Answer:

Addison’s disease is an autoimmune disorder of the adrenal glands caused by an unknown inflammation. It’s pretty rare in kids but somewhat more common in youngsters with type 1 diabetes. Thyroiditis and other thyroid problems occur about 20-40% of the time in kids with type 1 diabetes but Addison’s disease (adrenal insufficiency) occurs less than 1% of the time. Celiac disease, another autoimmune disorder, occurs about 8% of the time in kids with type 1 diabetes. Sometimes there is a strong family history of similar autoimmune disorders that suggest the possibility as well.

Tips for suspecting Addison’s in anyone, with or without diabetes, are unexplained fatigue, unexplained weight loss, poor growth, tanning that does not go away or is especially prominent even in the winter, dark pigmentation over scars or joint creases and/or nipple areas, low blood pressure or unexplained severe episodes of hypoglycemia.

The test you described is a classical one to test adrenal gland reserve and rather easy to accomplish in the office with just three blood samples to measure cortisol levels at half hour intervals. An adrenal antibody test could also be measured as could actual ACTH levels.

Go back and ask your son’s doctor why he is suspecting Addison’s, and whether or not celiac and thyroid problems have also been checked.

SB