Traps for the unwary

November 2010

FocusTraps for the unwary

Addison disease

Diagnosis and initial management

Volume 39, No.11, November 2010 Pages 834-837

Susan O’Connell

Aris Siafarikas


Adrenal insufficiency is a rare disease caused by either primary adrenal failure (Addison disease) or by impairment of the hypothalamic-pituitary-adrenal axis. Steroid replacement therapy normalises quality of life, however, adherence can be problematic.


This article provides information on adrenal insufficiency focusing on awareness of initial symptoms and on risk scenarios, emergency management and baseline investigations, complete investigations and long term management.


Early recognition of adrenal insufficiency is essential to avoid associated morbidity and mortality. Initial diagnosis and decision to treat are based on history and physical examination. Appropriate management includes emergency resuscitation and steroid administration. Initial investigations can include sodium, potassium and blood glucose levels. However, complete investigations can be deferred. Specialist advice should be obtained and long term management includes a Team Care Arrangement. For patients, an emergency plan and emergency identification are essential.

Primary adrenal insufficiency was first described by the English physician Thomas Addison in 1855.1 Addison disease is a rare condition with an estimated prevalence of 4–11 per 100 000 and an incidence of 0.8 per 100 000 population/year.2,3 In children, boys constitute approximately 75% of patients in contrast to adults, where the majority (70%) are women.4 The underlying pathology is a destruction of the cortex of the adrenal gland.5 Secretion of cortisol is reduced or absent, with or without associated reduction or absence of aldosterone. Adrenocorticotrophic hormone (ACTH) levels are increased.2

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