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Symptoms and signs are non specific resulting in delayed diagnosis of the condition (1)
- 60% of patients have consulted two or more doctors before Addison’s is considered as the cause
- according to a study of children with Addison’s disease
- delay in diagnosis was observed in about one third of cases
- median time for the correct diagnosis after the onset of first symptom was two years (1)
Symptoms become apparent when over 90% of the adrenal cortex is destroyed (1).
Features common to both primary and secondary hypoadrenalism include:
- lassitude and muscle weakness and pain
- hypotension - often marked in acute hypoadrenalism; usually postural in chronic disease with a fall in blood pressure on standing of 20 mm Hg or more after a few minutes - may cause dizziness and headache; due to ineffective catecholamine action
- gastro-intestinal symptoms - anorexia, weight loss, nausea and vomiting, intermittent abdominal pain salt, craving
- decrease in axillary and pubic hair - common in women
Pigmentation only occurs in primary hypoadrenalism, due to high ACTH:
- although characteristic, it is absent in about 10% of cases (1)
- the skin assumes a dull, grey-brown colouration
- exposed skin, pressure areas, palmar creases, knuckles, buccal mucosa and recent scars are the commonest sites
Pigmentation may be accompanied by vitiligo, resulting in a patchy appearance.
Other features of hypothalamic-pituitary disease, such as hypothyroidism, are only found in cases of secondary hypoadrenalism.
- impotence and amenorrhoea
- hypoglycaemia - reduced opposition to insulin-action
Features of associated conditions e.g. vitiligo, hypothyroidism, diabetes, premature ovarian failure, hypoparathyroidism may be present.
Last reviewed 01/2018