Intended for healthcare professionals

Practice Easily Missed?

Addison’s disease

BMJ 2009; 339 doi: (Published 02 July 2009) Cite this as: BMJ 2009;339:b2385
  1. Bijay Vaidya, consultant endocrinologist1, honorary senior clinical lecturer2,
  2. Ali J Chakera, specialist registrar1,
  3. Catherine Dick, general practitioner3
  1. 1Department of Endocrinology, Royal Devon and Exeter Hospital, Exeter EX2 5DW
  2. 2Peninsula Medical School, Exeter
  3. 3Devon Primary Care Trust, Topsham Surgery, Exeter EX3 0EN
  1. Correspondence to: B Vaidya, bijay.vaidya{at}

    Case scenario

    A 34 year old woman presented with a 12 month history of increasing tiredness, anorexia, weight loss, and depression. During that period, she had tried two different antidepressant tablets without benefit. She saw her general practitioner’s locum, who thought she looked tanned. Her blood pressure was 90/60 mm Hg, although it had always tended to be low. Her serum sodium concentration was 130 (normal range 135-145) mmol/l and potassium concentration was 5.7 (normal range 3.5-5.5) mmol/l. A short Synacthen (tetracosactide) test showed an inadequate serum cortisol response, which together with raised plasma adrenocorticotrophic hormone confirmed the diagnosis of Addison’s disease.

    What is Addison’s disease?

    Addison’s disease (also known as primary adrenal insufficiency) is a chronic disorder of the adrenal cortex resulting in inadequate secretion of glucocorticoid and mineralocorticoid. The commonest cause of Addison’s disease in developed countries is autoimmune disorder and in developing countries is tuberculosis.1

    How common is Addison’s disease?

    • Addison’s disease has a prevalence of 93-140 per million people and an annual incidence of 4.7-6.2 per million people in Western populations.1 2 A recent epidemiological study suggests that the incidence of Addison’s disease is rising2

    • A survey of patients with Addison’s disease found that 60% had seen two or more clinicians before the diagnosis of Addison’s disease was ever considered3

    • An observational study of children with Addison’s disease found that a delay in diagnosis occurred in about a third of the cases, in whom the median duration between the onset of first symptoms and the correct diagnosis was two years4

    Why is it missed?

    The onset of …

    View Full Text

    Log in

    Log in through your institution


    * For online subscription