Adrenal Insufficiency Symptoms
The typical symptoms of adrenal insufficiency are fatigue, weight loss, postural dizziness, anorexia, abdominal discomfort, and in primary adrenal insufficiency specifically, hyperpigmentation of sun-exposed areas, skin creases, and mucosal membranes. 1
Chronic Presentation Symptoms
The chronic symptoms are predominantly nonspecific, which frequently leads to delayed diagnosis and reduced quality of life 1:
Most Common Symptoms
- Fatigue (present in 50-95% of patients) - the most prevalent symptom 2
- Weight loss (43-73% of patients) 2
- Nausea and vomiting (20-62% of patients) 2
- Anorexia (43-73% of patients) 2
- Postural dizziness 1
- Abdominal discomfort 1
Distinguishing Features in Primary Adrenal Insufficiency
Hyperpigmentation is the most specific sign for primary adrenal insufficiency, though it is variably present and must be compared with the patient's baseline pigmentation 1. This occurs particularly in:
- Sun-exposed areas
- Skin creases
- Mucosal membranes
- Scars
- Areola of breast
Additional features unique to primary adrenal insufficiency include:
Clinical Signs
Physical examination findings include 1:
- Low blood pressure with increased postural drop
- Failure to thrive in children
Laboratory Abnormalities
While not symptoms per se, these laboratory findings often trigger diagnostic consideration 1, 5:
- Hyponatremia (present in 90% of newly presenting cases) 5
- Hyperkalemia (approximately 50% at diagnosis)
- Uncommonly: hypoglycemia, hypercalcemia
Adrenal Crisis Symptoms
Adrenal crisis is a medical emergency with distinct, severe symptoms 1:
- Severe weakness
- Syncope
- Abdominal pain, nausea, vomiting (may mimic acute abdomen)
- Back pain
- Confusion
- Hypotension
- Reduced consciousness or delirium
Important Clinical Pitfalls
The nonspecific nature of chronic symptoms means diagnosis is frequently delayed, which directly correlates with worse long-term quality of life 1. Early recognition is critical because even with optimal treatment, patients often experience reduced health-related quality of life 1.
In secondary adrenal insufficiency, hyperpigmentation is absent because ACTH levels are not elevated 1. This is a key distinguishing feature from primary adrenal insufficiency.
Children are more prone to hypoglycemia and hypoglycemic seizures compared to adults 5.
In the presence of severe vomiting, patients may paradoxically present with hypokalaemia and alkalosis rather than the expected hyperkalemia 5.