Adrenal gland and paraganglia
Adrenal insufficiency
Addison disease

Reviewer: Nat Pernick, M.D. (see Authors page)

Revised: 1 March 2016, last major update February 2005

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PubMed Search: Addison's disease [title]
Definition / General
  • Also called primary chronic adrenal insufficiency
  • Affects 3-6 individuals per 100,000 population
  • No symptoms until 90% of cortex is compromised;
  • More common in white women
  • Causes: autoimmune disorders, infections (Histoplasma, Coccidiodes, tuberculosis), space occupying lesions (metastases, lymphomas), hemorrhage, amyloid, sarcoid or hemochromatosis
  • Symptoms: progressive weakness, easy fatigability, anorexia, weight loss, depression, irritability, menstrual abnormalities, GI disturbances, hyperpigmentation (primary adrenal disease causes elevated ACTH, which stimulates melanocytes at sun-exposed areas and pressure points), small heart (due to chronic hypovolemia) and hypotension; infections may precipitate an acute crisis
  • Laboratory: elevated ACTH levels, low cortisol levels that do not respond to exogenous ACTH (since adrenal gland is damaged), hyponatremia, hypoglycemia, hyperkalemia and occasionally hypercalcemia
Gross Description
  • Irregularly shrunken glands, may be hard to find
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Addison disease