What are the symptoms of Addison's disease?
Addison’s disease is not usually apparent until over 90% of the adrenal cortex has been destroyed, so that very little adrenal capacity is left. This can take months to years and is known as primary adrenal insufficiency. Symptoms of the disease, once advanced, can include severe fatigue and weakness, loss of weight, increased pigmentation of the skin, faintness and low
blood pressure, nausea, vomiting, salt cravings and painful muscles and joints. Because of the rather non-specific nature of these symptoms and their slow progression, they are often missed or ignored until, for example, a relatively minor infection leads to an abnormally long convalescence which prompts an investigation. Frequently, it is not until a crisis is precipitated that attention is turned to the adrenals.
Addison's disease can cause irritability and depression. Because of salt loss, a craving for salty foods also is common. Hypoglycemia, or low blood glucose, is more severe in children than in adults. In women, menstrual periods may become irregular or stop. The slowly progressive loss of cortisol and aldosterone secretion usually produces a chronic, steadily worsening fatigue, a loss of appetite, and some weight loss. Blood pressure is low and falls further when a person is standing, producing lightheadedness. Nausea, sometimes with vomiting, and diarrhea are common. The muscles are weak and often go into spasm. There are often emotional changes, particularly irritability and depression. Because of salt loss, a craving for salty foods is common. Finally, the increase in ACTH due to the loss of cortisol will usually produce a darkening of the skin that may look like an inappropriate tan on a person who feels very sick. Unfortunately, the slowly progressive chronic symptoms are usually missed or ignored until a sudden event like a flu virus, an accident, or the need for surgery suddenly precipitates a dramatic change for the worse because of the deficient response from the adrenals to one of these stresses. This is referred to as an Addisonian crisis and is a medical emergency.
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 cases, symptoms are severe enough that patients 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.