Addison's disease

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  • Primary adrenal insufficiency
  • Bilateral adrenal destruction by tuberculosis used to be most common cause, now only accounts for 7-20% of cases
  • Autoimmune disease 70-90%, remainder caused by infectious disease, metastasis or lymphoma, adrenal hemorrhage, infarction, or drugs.
  • Typically presents in adults between 30 and 50 years of age
    • All ages, races, genders can be affected
  • Higher incidence with other autoimmune deficiencies

Clinical Features

  • Abdominal pain
  • Weakness and fatigue
  • Salt craving
  • Abnormal skin pigmentation - will often look patchy
  • Addisonian Crisis
    • Hypotension
    • Neurologic Symptoms: coma

Differential Diagnosis

  • Corticosteroid withdrawal
  • Secondary adrenal insufficiency - deficiency of ACTH (produced by the pituitary gland)
  • Tertiary adrenal insufficiency - deficiency of CRH (produced by the hypothalamus)


Laboratory findings




  • New Diagnosis: strong consideration for admission
  • Crisis?: Consider admission based on electrolytes and clinical presentation

See Also

External Links


  1. de Herder WW, van der Lely AJ (May 2003). "Addisonian crisis and relative adrenal failure". Reviews in Endocrine and Metabolic Disorders 4 (2): 143–7.