This site is intended for healthcare professionals

Go to /sign-in page

You can view 5 more pages before signing in

Clinical features

Last reviewed dd mmm yyyy. Last edited dd mmm yyyy

Authoring team

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.

Uncommonly:

  • 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.

Reference:


Related pages

Create an account to add page annotations

Add information to this page that would be handy to have on hand during a consultation, such as a web address or phone number. This information will always be displayed when you visit this page