Table 2

Clinical manifestations of primary adrenal insufficiency

SymptomsSignsLaboratory findings
  • Fatigue and lethargy.

  • Weight loss.

  • Salt craving.

  • Postural dizziness.

  • Anorexia.

  • Abdominal discomfort.

  • Joint and muscle aches.

  • Loss of axillary and pubic hair in women due to loss of adrenal androgens.

  • Increased pigmentation of the skin and mucous membranes, especially on sun-exposed areas and those subject to friction, such as knuckles, skin creases, elbows, scars, breast areola (caused by stimulation of dermal melanocortin receptors due to high ACTH and other pro-opiomelanocortin peptides).

  • Low blood pressure.

  • Orthostatic hypotension.

  • Failure to thrive in children.

  • Hyponatraemia.

  • Hyperkalaemia.

  • Hypoglycaemia.

  • Hypercalcaemia.

  • Normochromic anaemia, eosinophilia and lymphocytosis.

  • ACTH, adrenocorticotropic hormone.