What are the symptoms of adrenal insufficiency?

Symptoms of Adrenal Insufficiency

The key symptoms of adrenal insufficiency include fatigue, weight loss, anorexia, postural hypotension, abdominal pain, muscle pain, hyponatremia, and in primary adrenal insufficiency, skin hyperpigmentation and salt craving. 1, 2

Common Clinical Manifestations

General Symptoms

• Profound fatigue and weakness (50-95% of patients) 2
• Unintentional weight loss (43-73% of patients) 2
• Anorexia (loss of appetite) (43-73% of patients) 2
• Nausea and vomiting (20-62% of patients) 2

Cardiovascular Symptoms

• Postural hypotension (may lead to dizziness when standing) 1
• Hypotension (in severe cases or adrenal crisis) 3
• Risk of cardiovascular collapse in acute adrenal crisis 4

Gastrointestinal Symptoms

• Abdominal pain 1
• Nausea and vomiting 2
• Diarrhea 3

Musculoskeletal Symptoms

• Muscle pain and weakness 1
• Reduced work capacity 1

Laboratory Abnormalities

• Hyponatremia (low sodium) - present in 90% of newly presenting cases 3
• Hyperkalemia (high potassium) - present in approximately 50% of cases 3
• Mild to moderate hypercalcemia (10-20% of patients) 3
• Acidosis 3
• Hypoglycemia (more common in children) 3
• Anemia, mild eosinophilia, lymphocytosis 3
• Elevated liver transaminases 3

Specific to Primary Adrenal Insufficiency

• Skin hyperpigmentation (particularly in skin folds, pressure points, and mucous membranes) 1, 2
• Salt craving 1
• Volume depletion due to loss of aldosterone 3

Neuropsychiatric Symptoms

• Altered mental status (especially during adrenal crisis) 2
• Irritability 5

Severity Classification

Mild Symptoms (Grade 1)

• Asymptomatic or mild symptoms 3
• Patient able to perform daily activities 3

Moderate Symptoms (Grade 2)

• Moderate symptoms affecting daily activities 3
• Patient still able to perform activities of daily living 3

Severe Symptoms (Grade 3-4)

• Severe symptoms with medically significant or life-threatening consequences 3
• Patient unable to perform activities of daily living 3
• May progress to adrenal crisis with hypotension, shock, altered mental status 2

Adrenal Crisis

• Acute presentation with severe hypotension or shock 6
• Altered mental status 2
• Severe abdominal pain, nausea, and vomiting 3
• Fever 5
• Unexplained collapse 3
• Can be precipitated by acute illness, physical stress, or sudden interruption of steroid therapy 6
• Life-threatening if not treated promptly 1

Important Clinical Considerations

• Symptoms are often non-specific, leading to delayed diagnosis 1, 5
• Adrenal crisis occurs in approximately 50% of patients with adrenal insufficiency after diagnosis 1
• Early recognition and treatment of symptoms can prevent progression to adrenal crisis 5
• Patients with known adrenal insufficiency need education on increasing medication during illness or stress 1
• Symptoms may be exacerbated during acute stress situations 6