Addison's disease history and symptoms

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Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]

History and Symptoms

Symptoms

The symptoms of adrenal insufficiency develop insidiously, usually begin gradually, and they may take some time to be recognized. Some have marked cravings for salty foods due to the loss of sodium in the urine. Characteristics of the disease are;

• Chronic, worsening fatigue
• Muscle weakness
• Loss of appetite
• Weight loss
• Headache
• Sweating
• Changes in mood and personality

About 50 percent of the time, one will notice;

• Nausea
• Vomiting
• Diarrhea
• Dizziness or fainting - due to low blood pressure that falls further when standing

Addison's disease can cause irritability and depression. Because of salt loss, a craving for salty foods is also common. Hypoglycemia, or low blood glucose, is more severe in children than in adults. In women, menstrual periods may become irregular or stop. Because the symptoms progress slowly, they are usually ignored until a stressful event like an illness or an accident causes them to become worse. This is called an addisonian crisis, or acute adrenal insufficiency. In most cases, symptoms are severe enough that patients seek medical treatment before a crisis occurs. However, in about 25 percent of patients, symptoms first appear during an addisonian crisis.

Symptoms of an addisonian crisis include;

Left untreated, an addisonian crisis can be fatal.

Type of presentation	Harmone deficiency	Common symptoms	Less common symptoms
Acute adrenal insufficiency	Mainly cortisol	Sudden penetrating pain in the lower back, abdomen, or legs Severe vomiting and diarrhea Dehydration Low blood pressure - dizziness and fainting Loss of consciousness	In acute adrenal hemorrhage, Deteriorates with sudden collapse, Abdominal or flank pain, Nausea with or without hyperpyrexia.
Chronic adrenal insufficiency	Primary: Both glucocorticoid, mineralocorticoid	Hyperpigmentation (prominent on the sun-exposed areas of the skin, extensor surfaces, knuckles, elbows, knees) Progressive weakness, fatigue, poor appetite, and weight loss. Nausea, vomiting, and occasional diarrhea. Muscle pains Joint pains
	Secondary: Glucorticoid

Symptoms	Pathophysiology
Hyperpigmentation	Stimulant effect of excess ACTH on the melanocytes to produce melanin
Dizziness with orthostasis	Volume depletion, loss of the mineralocorticoid effect of aldosterone, Loss of the permissive effect of cortisol in enhancing the vasopressor effect of the catecholamines.
Myalgias and flaccid muscle paralysis	Hyperkalemia
Amenorrhea	Combined effect of weight loss and chronic ill health or secondary to premature autoimmune ovarian failure