From the Guidelines
Adrenal insufficiency presents with a constellation of symptoms resulting from inadequate cortisol production, including extreme fatigue, weakness, weight loss, decreased appetite, nausea, vomiting, abdominal pain, low blood pressure, dizziness, and salt cravings, as noted in the most recent guideline update 1.
Common Symptoms
- Extreme fatigue
- Weakness
- Weight loss
- Decreased appetite
- Nausea
- Vomiting
- Abdominal pain
- Low blood pressure (especially upon standing)
- Dizziness
- Salt cravings
Additional Symptoms
Patients may also experience hyperpigmentation (darkening of the skin), particularly in skin folds, scars, and pressure points, which is more common in primary adrenal insufficiency (Addison's disease) 1. Mood changes, irritability, depression, and difficulty concentrating can occur. Women may experience loss of body hair and decreased libido. Hypoglycemia (low blood sugar) can develop, especially during fasting. In acute adrenal crisis, symptoms become severe and potentially life-threatening, including severe pain, profound weakness, confusion, and shock.
Importance of Education and Emergency Preparedness
All patients need education on stress dosing for sick days, use of emergency injectables, when to seek medical attention for impending adrenal crisis, and a medical alert bracelet or necklace for adrenal insufficiency to trigger stress dose corticosteroids by emergency medical personnel, as emphasized in the guideline update 1. Endocrine consultation should be part of planning before surgery or high-stress treatments, and patients should carry emergency medication and wear medical identification 1.
From the Research
Symptoms of Adrenal Insufficiency
The symptoms of adrenal insufficiency (Addison's disease) can be non-specific and varied, making it a challenging condition to diagnose. Some common symptoms include:
- Fatigue 2, 3, 4
- Weight loss 3, 5, 4
- Anorexia 3
- Postural hypotension 3
- Muscle and abdominal pain 3
- Hyponatraemia 3
- Skin hyperpigmentation (specific to primary adrenal insufficiency) 3, 4
- Nausea and vomiting 5
- Syncope 5
- Hypoglycemia 5
- Gastrointestinal manifestations 4
Diagnosis and Management
Diagnosis of adrenal insufficiency is often delayed due to the non-specific nature of the symptoms. However, early detection and testing based on clinical suspicion can prevent subsequent presentation with adrenal crisis 6. The diagnosis can be confirmed by specific testing such as the cosyntropin stimulation test 2, 6 or the insulin tolerance test 6. Treatment consists of glucocorticoid and mineralocorticoid replacement 5, and patient education is crucial in managing the condition and preventing adrenal crisis 3, 6, 4.