Symptoms of Addison's Disease
Addison's disease presents with a characteristic set of symptoms including persistent fatigue, unintentional weight loss, hypotension, hyperpigmentation of the skin (especially in areas subjected to friction), and electrolyte abnormalities such as hyponatremia and hyperkalemia. 1, 2, 3
Common Clinical Manifestations
Physical Symptoms
- Persistent fatigue and weakness (myasthenia)
- Unintentional weight loss
- Hypotension (often orthostatic)
- Gastrointestinal symptoms:
- Anorexia
- Nausea
- Diarrhea
- Joint and back pain
- Fever (especially during adrenal crisis)
Dermatological Signs
- Hyperpigmentation (a hallmark finding):
- More pronounced in sun-exposed areas
- Prominent in palmar creases
- Visible on frictional surfaces
- Affects the vermilion border of lips
- Present on recent scars
- Noticeable on genital skin
- Appears on oral mucosa 2
Laboratory Abnormalities
- Electrolyte disturbances:
- Hyponatremia (low sodium)
- Hyperkalemia (high potassium)
- Hypoglycemia (especially during stress)
Neuropsychiatric Manifestations
Addison's disease can also present with various neuropsychiatric symptoms, including:
Acute vs. Chronic Presentation
Acute Adrenal Crisis
- Severe hypotension or shock
- Fever, chills, sweats (or hypothermia)
- Altered mental status
- Severe headache
- Profound weakness
- Abdominal pain
- Requires immediate medical attention 4
Chronic Presentation
- Insidious onset of symptoms
- General malaise
- Progressive fatigue
- Gradual weight loss
- Slowly developing hyperpigmentation 5, 3
Diagnostic Challenges
Addison's disease is often overlooked or diagnosed late due to:
- Nonspecific early symptoms that mimic other conditions
- Insidious onset of symptoms
- Rarity of the condition 5, 3
The presence of hyperpigmentation along with fatigue, weight loss, and hypotension should raise immediate clinical suspicion for Addison's disease and prompt appropriate testing, including measurement of morning cortisol, ACTH, and potentially an ACTH stimulation test 2, 3.
Early recognition of symptoms is crucial as untreated adrenal insufficiency can progress to life-threatening adrenal crisis, characterized by severe hypotension, electrolyte imbalances, and altered mental status 4.