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2437 pages added, reviewed or updated during the last month (last updated: 22/4/2021)

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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
  • depression

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
  • diarrhoea

Features of associated conditions e.g. vitiligo, hypothyroidism, diabetes, premature ovarian failure, hypoparathyroidism may be present.


Last reviewed 01/2018