Gill and Williams introduced “brittle Addison’s disease” as a term to describe a subset of patients with Addison’s disease who are difficult to manage. Brittle was used to indicate similarities with brittle diabetes or brittle asthma. The authors are from University Hospital Aintree in Liverpool, England.


Patient selection: Addison’s disease


Clinical features:

(1) unstable and/or unpredictable disease with frequent hospital admissions and/or emergency department visits for hypo-adrenal crisis

(2) psychosocial disruption

(3) poor adherence to steroid replacement therapy


Management involves interventions to:

(1) address the psychiatric and/or social issues

(2) improve adherence


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