Addison's Disease Clinical Presentation

Chronic Clinical Manifestations

The American College of Endocrinology notes that Addison's disease presents with a characteristic constellation of chronic symptoms including hyperpigmentation, fatigue, weight loss, and hypotension, along with laboratory findings of hyponatremia, hyperkalaemia, low cortisol, and elevated ACTH 1
Hyperpigmentation often has an uneven distribution pattern, especially in sun-exposed areas, palmar creases, and frictional surfaces 2, 3
Salt craving is a specific symptom reflecting mineralocorticoid deficiency 1
Nausea occurs in 20-62% of patients, and morning nausea and lack of appetite are particularly common 4
Muscle pain or cramps, especially during acute crisis, are common musculoskeletal symptoms 5

Hyponatremia is present in 90% of newly diagnosed cases, and hyperkalaemia occurs in approximately 50% of cases 1, 4
The absence of hyperkalemia cannot rule out Addison's disease, and mild to moderate hypercalcemia occurs in 10-20% of patients at presentation 4
Low serum cortisol and elevated plasma ACTH levels are characteristic hormonal findings 1, 4
Low DHEAS, androstenedione, and testosterone levels indicate androgen deficiency 6

The Endocrine Society notes that acute adrenal crisis presents with malaise, severe fatigue, nausea, vomiting, abdominal pain, dehydration, hypotension, shock, loss of consciousness, and coma 5
Hypoglycemia, particularly in children during acute crisis, and increased creatinine due to prerenal renal failure are other laboratory abnormalities that may occur 5

The American Association of Clinical Endocrinologists warns that the insidious nature of symptom development over months to years often leads to delayed diagnosis, and symptoms are frequently non-specific in early stages 1
The European Society of Endocrinology advises not to rely solely on electrolyte abnormalities for diagnosis, as some patients may have normal electrolytes or only mild abnormalities at presentation 4