What is an anti-adrenal antibody screen?

The adrenal glands are two small glands each located above the kidneys. These glands are composed of two parts: an external part called the “adrenal cortex” and a central part called the “adrenal medulla.” The adrenal cortex is responsible for producing several hormones important for human health, such as cortisol and corticosterone, which affect the body’s response to stress (infections, surgeries, burns, hypoglycemia, etc.), and aldosterone, which is strongly involved in controlling blood pressure. The adrenal cortex also produces androgens (masculinizing hormones).

The immune system is responsible for defending the body against attacks from foreign cells and organisms: bacteria, viruses, parasites and transplanted cells. Often, the immune system goes awry and confuses some of its own tissues as foreign. The production of antibodies against its own tissues is the cause of a large number of “autoimmune” diseases. Rheumatoid arthritis, lupus, pernicious anemia, juvenile diabetes and several thyroid disorders are autoimmune in origin.

When the immune system produces antibodies against the adrenal cortex, it leads to adrenal insufficiency, also called Addison’s disease. This disorder is most often caused by the presence of these anti-adrenal antibodies. Often, the presence of anti-adrenal antibodies is the only detectable autoimmune disorder, but sometimes, it is part of a combination of other autoimmune disorders (hypothyroidism, pernicious anemia, type 1 diabetes, etc.).

A defect in the production of cortisol and aldosterone (adrenal insufficiency) is a serious medical condition manifested primarily by fatigue, anemia, a loss of appetite, weight loss and, at times, a craving for salty foods. Depending on the case, adrenal insufficiency can sometimes have more serious consequences: lower blood sugar levels (hypoglycemia), low blood pressure which can cause fainting (syncope), nausea, vomiting and, in the most severe cases, a coma.

An anti-adrenal antibody assay is not prescribed as a first line of investigation. Given a suggestive clinical picture (symptoms, abnormal sodium and potassium levels in the blood, etc.), the best test for diagnosing Addison’s disease is a cortisol assay in blood and urine, with or without an ACTH test (see this section). In the presence of primary adrenal insufficiency (low cortisol levels and very high ACTH levels), a doctor can confirm the presence of an autoimmune disorder by testing for anti-adrenal antibodies.

Even in the absence of abnormal cortisol levels and typical symptoms of adrenal insufficiency, anti-adrenal antibody screening is sometimes indicated in the presence of other autoimmune disorders (polyendocrinopathies) in order to assess the risk of developing adrenal insufficiency.

A positive anti-adrenal antibody (or anti-21-hydroxylase) result indicates the presence of adrenal antibodies compatible with active or developing Addison’s disease.

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