Endocrinology & MetabolicPending review

Addison's Disease

Autoimmune destruction of the adrenal cortex that removes cortisol and aldosterone together, so the clinical picture (fatigue and hypoglycaemia from cortisol loss, hyperpigmentation from unchecked ACTH, and salt-wasting hypotension from aldosterone loss) can be predicted from which hormone is missing.

In a nutshell

Autoimmune destruction of the adrenal cortex removes cortisol and aldosterone together. Cortisol loss causes fatigue, hypoglycaemia and an inability to cope with stress; unchecked ACTH causes hyperpigmentation; aldosterone loss causes salt-wasting hypotension and hyperkalaemia. Any stressor can precipitate a life-threatening crisis.

Classic presentation

Insidious fatigue, weight loss, postural dizziness and skin pigmentation, with hyponatraemia and hyperkalaemia, occasionally presenting acutely in crisis with collapse and shock during an intercurrent illness.

Key points

Primary adrenal failure loses cortisol and aldosterone together; secondary (pituitary) failure spares aldosterone, which is why hyperkalaemia and marked hypotension favour a primary cause.

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Educational content pending clinical review. Not medical advice.