The symptoms of adrenal insufficiency usually begin gradually. Chronic, worsening fatigue and muscle weakness,
loss of appetite, and weight loss are characteristic of the disease. Nausea, vomiting, and diarrhea occur in about
50 percent of cases. Blood pressure is low and falls further when standing, causing dizziness or fainting. Skin
changes also are common in Addison's disease, with areas of hyperpigmentation, or dark tanning, covering exposed
and nonexposed parts of the body. This darkening of the skin is most visible on scars; skin folds; pressure points
such as the elbows, knees, knuckles, and toes; lips; and mucous membranes.
Addison's disease can cause irritability and depression. Because of salt loss, craving of salty foods also is common.
Hypoglycemia, or low blood sugar, is more severe in children than in adults. In women, menstrual periods may become
irregular or stop.
Because the symptoms progress slowly, they are usually ignored until a stressful event like an illness or an accident
causes them to become worse. This is called an addisonian crisis, or acute adrenal insufficiency. In most patients,
symptoms are severe enough to seek medical treatment before a crisis occurs. However, in about 25 percent of patients,
symptoms first appear during an addisonian crisis.
Symptoms of an addisonian crisis include sudden penetrating pain in the lower back, abdomen, or legs; severe vomiting
and diarrhea, followed by dehydration; low blood pressure; and loss of consciousness. Left untreated, an addisonian
crisis can be fatal.
This e-pub was written by Eileen K. Corrigan of NIDDK's Office of Health Research Reports. The draft was reviewed
by Dr. George P Chrousos, National Institute of Child Health and Human Development, Dr. Judith
Institute of Diabetes and Digestive and Kidney Diseases, and by Dr. Richard Horton, University of Southern California
NIH Publication No. 90-3054
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