Clinical presentation

The clinical presentation of adrenal insufficiency varies, depending on the degree of adrenal dysfunction, the acuteness with which function is lost, the extent of mineralocorticoid production, and the magnitude of superimposed stress or medical illness.

Common symptoms of adrenal insufficiency are:

  • generalized weakness
  • malaise
  • easy fatigue
  • loss of appetite
  • weight loss

Seizures can occur in association with hyponatremia. They are treated by correcting serum sodium and glucose concentrations.

An adrenal crisis may result from infection or other stress superimposed on adrenal insufficiency or from bilateral adrenal infarction or hemorrhage. The usual presenting clinical picture is shock. Nausea, vomiting, abdominal pain, confusion, or coma may occur as well.

Patients with chronic primary adrenal insufficiency have hyperpigmented skin, especially in areas exposed to sun or contact pressure. Other possible findings include mood instability, psychotic ideation, and an encephalopathy varying from inattention to delirium and stupor.

SIADH due to cortisol deficiency and volume loss due to mineralocorticoid deficiency causes hyponatremia in 85-90% of patients. Hyperkalemia, hyperchloremic acidosis, and hypoglycemia may be present.

Adapted from: Schachter SC and Lopez MR. Metabolic disorders. In: Ettinger AB and Devinsky O, eds. Managing epilepsy and co-existing disorders. Boston: Butterworth-Heinemann; 2002;195–208. 
With permission from Elsevier ( 

Reviewed By: 
Steven C. Schachter, MD