Part of “CHAPTER 76 – ADRENOCORTICAL INSUFFICIENCY“

The symptoms and signs of primary and secondary adrenal insufficiency can be categorized as related to the chronic and acute syndromes.34 Symptoms of the chronic syndrome include weakness, fatigue, anorexia, nausea, abdominal pain, and diarrhea. An occasional patient, particularly one with primary adrenal insufficiency, complains of orthostatic dizziness and, rarely, syncope. Signs include weight loss and, particularly in primary insufficiency, orthostatic hypotension. Symptoms and signs specific to primary adrenal insufficiency include salt craving and pigmentation of the skin and mucous membranes (Fig. 76-1,Fig. 76-2 and Fig. 76-3). Vitiligo and alopecia also can occur in the autoimmune form of primary adrenal insufficiency.35 Radiologic findings include large, often calcified, glands in patients with an infectious cause.20 The symptoms of the acute syndrome include muscle, joint, and abdominal pain, and postural hypotension. Associated signs include fever, hypotension, and clouded sensorium. The patient may appear dehydrated. No hyperpigmentation is seen in acute primary adrenal insufficiency, unless the acute insufficiency is superimposed on a prior chronic condition.