Addison's Disease

Symptoms

Addison's disease develops when the adrenal glands, located above the kidneys, are not able to produce enough of the hormones cortisol and aldosterone. In most cases, the adrenal glands fail slowly and symptoms begin gradually. However, symptoms may appear rapidly if the adrenal glands are destroyed suddenly, such as from trauma or severe bleeding (hemorrhage). The most obvious and common symptoms of Addison's disease include:

• Fatigue and muscle weakness that gradually worsen over time.
• Weight loss. Profound weight loss is a common symptom.
• Loss of appetite.

Other symptoms include:

• Darkening of the skin, or hyperpigmentation. This occurs especially:
  • Over new scars.
  • In skin folds.
  • On the lips and tissue lining the mouth and nose.
  • Over joints such as the elbows, knees, knuckles, and toes.
  • In the creases of the palms.
  • On the nipples and surrounding areas (areola).
• Light-headedness or fainting when getting up from a sitting or lying position. This is called orthostatic hypotension.
• Nausea, vomiting, diarrhea, and abdominal pain.
• A craving for salty foods.
• Shakiness. People with Addison's disease sometimes have low blood sugar.
• Difficulty concentrating, increased irritability, and depression.

Because symptoms develop slowly, they often are not obvious until an adrenal crisis (Addisonian crisis) occurs. An adrenal crisis is caused by a stressful event, such as a severe infection, trauma, surgery, or dehydration. The body is not able to produce enough cortisol to cope with stress. If an adrenal crisis is not treated, you may die from shock caused by a serious drop in blood pressure. Symptoms of an adrenal crisis include:

• Severe vomiting and diarrhea that lead to a dangerous loss of body fluids (dehydration).
• Extreme weakness, light-headedness, or feeling that you are going to pass out.
• Sudden pain in the abdomen, lower back, and legs.
• Abnormal behaviour, such as restlessness, confusion, or feeling fearful.
• Changes in level of consciousness, such as having difficulty staying awake, suddenly not being responsive, or a total loss of consciousness.
• High fever.
• Pale face and blue lips and earlobes.

A wide range of illnesses—many of them not serious—can have symptoms similar to those of Addison's disease. Other conditions with similar symptoms range from diarrhea and other gastrointestinal problems to more serious illnesses such as hepatitis or cancer.

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Author:	Douglas Dana Shannon Erstad, MBA/MPH	Last Updated: May 18, 2006
Medical Review:	Kathleen Romito, MD - Family Medicine Tom Bailey, MD - Family Medicine Alan C. Dalkin, MD - Endocrinology
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