Addison’s disease

1. Big picture

Addison’s disease = primary adrenal insufficiency, meaning the adrenal cortex fails to produce enough cortisol and usually aldosterone. The examiner wants you to recognize the classic pattern:

chronic fatigue + weight loss + hypotension + salt craving + hyperpigmentation + hyponatremia + hyperkalemia

The dangerous form is adrenal crisis, which presents with shock, vomiting, abdominal pain, confusion, hypoglycemia, hyponatremia, and hyperkalemia. In adrenal crisis, do not wait for confirmatory tests: draw blood if possible, then give immediate hydrocortisone and intravenous saline. Endocrine Society guidance recommends immediate treatment in severe symptoms/adrenal crisis and confirmatory corticotropin stimulation testing when the patient is stable. ([Endocrine Society][1])

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