Addison’s disease: identification and management in primary care

Abstract

Addison’s disease (AD), also known as primary adrenal insufficiency, is a deficiency of glucocorticosteroids and mineral corticosteroids.1 This can result in an insidious, protracted presentation. Therefore, unsurprisingly, the diagnosis is often delayed2 and 60% of patients have seen two or more clinicians before the diagnosis is considered.3 Around one-half of patients with AD are diagnosed after an acute adrenal crisis,4 which can be rapidly fatal.5 Although tuberculosis is the most common cause of AD worldwide,1 in the developed world, autoimmune disease is the predominant cause.3 In the latter context, AD is often linked to other autoimmune diseases, such as, vitiligo.6