Primary adrenal insufficiency, Addison disease, is a progressive adrenal hypofunction that usually presents insidiously. However, an acute presentation called an Addisonian crisis can be the presenting feature of Addison disease and is usually provoked by an acute infection. Clinical features of Addison disease include hypotension, postural dizziness, nausea, weight loss and lethargy. On examination, patients have hyperpigmentation of the skin and buccal mucosae, and low blood pressure often accompanied with postural blood pressure drop and cardiovascular collapse when Addisonian crisis occurs. Primary adrenal insufficiency is caused by autoimmune adrenalitis in around 70% of patients, but other causes such as bilateral adrenal hemorrhage, granulomatous disease (eg, tuberculosis) or metastatic malignancy can also cause this disease. Treatment of Addison disease includes longterm replacement of glucocorticoids and mineralocorticoids, and patients should be educated on how to increase replacement in case of an acute illness.
See Addison Disease in The Manuals for more details.
References
Barthel A, Willenberg HS, Gruber M, Bornstein SR. Adrenal insufficiency. In: Jameson JL, De Groot LJ, eds. Handbook of Endocrinology: Adult and Pediatric. 7th ed. Philadelphia, PA: Saunders; 2016: 1763-1775.
Back