A patient with chronic adrenal insufficiency may present dramatically with acute adrenal crisis (see above) or with a number of clinical findings that can be subtle and easily overlooked.


Factors affecting the presentation of adrenal insufficiency:

(1) speed of evolution (acute, subacute, chronic, acute on chronic)

(2) cause of the adrenal insufficiency

(3) severity of comorbid conditions

(4) presence of mineralocorticoid deficiency in additional to cortisol deficiency


Features of chronic adrenal insufficiency may include:

(1) hyperpigmentation, especially involving sun-exposed skin or mucous membranes

(2) variable vitiligo

(3) malaise

(4) fatigue, easy fatiguability, tiredness

(5) nausea and vomiting

(6) constipation or diarrhea

(7) anorexia

(8) abdominal pain

(9) muscle cramps

(10) arthralgias

(11) postural hypotension

(12) loss of axillary and pubic hair

(13) memory loss and cognitive impairment

(14) depression and/or psychosis

(15) salt-craving


Features seen in chronic adrenal insufficiency due to pituitary destruction:

(1) loss of libido

(2) infertility

(3) oligomenorrhea or amenorrhea in females

(4) cold intolerance

(5) weight gain or loss

(6) fasting hypoglycemia


Laboratory findings:

(1) hyperkalemia

(2) hypercalcemia

(3) hyponatremia

(4) azotemia

(5) anemia

(6) eosinophilia


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