The specific test for this young woman’s ACTH stimulation test is the diagnostic test for primary adrenal insufficiency. The analysis is performed in the morning at 8 am when the cortisol level is high. Moreover, this test provides both the cortisol and ACTH levels in the blood. Any abnormality in ACTH stimulation test either a low level of cortisol or high level of ACTH will explain the entire complex symptoms associated with Addison disease such as hyper-pigmentation due to increased levels of ACTH (Charmandari et al. 2014).

Other possible tests are; insulin tolerance test used to diagnose primary as well as secondary Addison disease (Adrenal insufficiency), the CRH stimulation test is also appropriate, the test measures the levels of cortisol and ACTH following stimulation of the pituitary gland by injecting synthetic corticotropin-realizing hormone (CRH). An MRI scanning can also be recommended to image her adrenal and pituitary glands to determine their appearances. The adrenal insufficiency can either be primary or secondary insufficiency (Bornstein et al., 2016). The primary adrenal insufficiency is commonly caused by autoimmune adrenalitis (damage to the adrenal cortex by the body’s immunity system).

While the secondary adrenal system is caused by damage to hypothalamus or pituitary gland resulting in ACTH deficiency, also suppression of the adrenal gland after glucocorticoid or ACTH administration can lead to the secondary type case. However, the secondary types are linked to lack of cortisol, unlike the primary adrenal insufficiency that is associated with mineralocorticoid deficiency. Low level of sodium and increased level of potassium by cortisol and aldosterone deficiency respectively, following increased secretion of antidiuretic hormone leading to low plasma sodium concentration, and increased potassium secretion by hypoaldosteronism.

References

Bornstein, S. R., Allolio, B., Arlt, W., Barthel, A., Don-Wauchope, A., Hammer, G. D., … & Torpy, D. J. (2016). Diagnosis and treatment of primary adrenal insufficiency: an endocrine society clinical practice guideline. The Journal of Clinical Endocrinology & Metabolism, 101(2), 364-389.

Charmandari, E., Nicolaides, N. C., & Chrousos, G. P. (2014). Adrenal insufficiency. The Lancet, 383(9935), 2152-2167.

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