A chronic disorder caused by destruction or dysfunction of the adrenal cortex, leading to deficiency of cortisol, aldosterone, and adrenal androgens. Untreated, it can be life-threatening, particularly during physiological stress.
🚨 Inadequate cortisol response during illness, surgery, or trauma can cause an Addisonian crisis – a true endocrine emergency.
| Cause | Notes |
|---|---|
| Autoimmune adrenalitis | Most common in the UK |
| Infections | Tuberculosis, fungal infections |
| Metastatic cancer | Especially lung or breast primary |
| Adrenal haemorrhage | Seen in meningococcal sepsis |
| Genetic disorders | Rare, e.g. congenital adrenal hyperplasia |
💡 Autoimmune adrenalitis often coexists with other autoimmune diseases such as type 1 diabetes or autoimmune thyroid disease.
Loss of cortisol → impaired stress response, hypoglycaemia
Loss of aldosterone → sodium loss, potassium retention, hypotension
Loss of adrenal androgens → reduced secondary sexual characteristics (mainly in women)
Fatigue, weight loss, anorexia
Nausea, vomiting, abdominal pain
Postural hypotension, dizziness, salt craving
Hyperpigmentation – palmar creases, mucosa, scars
Hypoglycaemia (especially in children)
🚨 Triad of hyperpigmentation, hypotension, and hyponatraemia should raise strong suspicion.
Hypotension or shock unresponsive to fluids
Severe vomiting, diarrhoea, confusion, collapse
Precipitated by infection, surgery, missed steroid doses, or trauma
🚨 Requires immediate IV hydrocortisone and fluid resuscitation — do not delay for test results.
U&E: hyponatraemia, hyperkalaemia
Blood glucose: low
Morning cortisol: reduced
ACTH stimulation (Synacthen) test: failure to rise
Plasma ACTH: high in primary adrenal insufficiency
Acute crisis: urgent IV hydrocortisone + IV fluids
Chronic therapy: lifelong glucocorticoid ± mineralocorticoid replacement
Education: stress-dose steroids during illness/surgery, medical alert ID, emergency hydrocortisone kit
Addisonian crisis
Chronic fatigue
Increased infection risk
Osteoporosis from long-term steroid therapy
