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Personal Views Personal views

My Addison's disease

BMJ 2000; 321 doi: https://doi.org/10.1136/bmj.321.7261.645 (Published 09 September 2000) Cite this as: BMJ 2000;321:645

Addison's: after 40 years much remains the same

To the Editor,

Kathleen Hilditch’s diagnosis with Addison's disease took place 40
years ago when blood tests were more expensive and less frequently
employed for general screening (Personal views, 9 September). However,
her experience that Addison’s was not diagnosed until she was near death
is still common to a significant number of Addisonians today, prompting
the remark that: “Getting diagnosed is the hardest part of this disease”.

Early detection of Addison’s disease is not easy: the patient’s
experience of non-specific fatigue-related symptoms may be overlaid by
signs of depression (as is also the case with hypothyroidism). Some
patients never develop the full classical triad of hyperpigmentation,
hypotension and hyponaetremia. The nature of the disease also means that
Addisonians who have been struggling with sub-clinical symptoms for years
as their adrenal function deteriorated suddenly become vulnerable to a
“crisis” when they meet a flu virus or other illness which they no longer
have the adrenal reserves to combat. Some Addisonians report having been
hospitalised with a crisis more than once before they are, in fact,
diagnosed.

In some cases, the reluctance of medical practitioners to consider an
uncommon cause of disease remains a factor in late diagnosis. We would
like to remind readers that it is only four years since the BMJ ran a
feature documenting the deaths of two patients whose Addison’s disease was
not diagnosed until autopsy (Lesson of the Week: Addison’s Disease, BMJ
1996:312 1085-87). The first of these deaths took place in hospital;
simple screening tests had raised Addison’s as a possibility but were not
acted on.

Addison's is a relatively cheap and simple disease to treat. Our hope
is that, by raising awareness of the condition, patients like Kathleen
Hilditch do not have to live with poor and deteriorating health until such
time as an Addisonian crisis requiring hospitalisation prompts diagnosis.

Yours sincerely,

Sarah Baker

Deana Kenward

Katherine G White

UK ADDISON’S DISEASE SELF-HELP GROUP

Competing interests: No competing interests

27 September 2000
Katherine G White
Sarah Baker, Deana Kenward