Intended for healthcare professionals

Rapid response to:

Practice Easily Missed?

Addison’s disease

BMJ 2009; 339 doi: (Published 02 July 2009) Cite this as: BMJ 2009;339:b2385

Rapid Response:

Addison's disease: failure to diagnose can be fatal

Our thanks to Vaidya, Chakera and Dick for their concise and balanced
overview of the complexities of diagnosing Addison’s disease and for their
important reminder that failure to diagnose can be fatal.

Death from undiagnosed or under-treated adrenal failure is now
thankfully rare, but still occurs each year in a few tragic cases. The
Office of National Statistics records that an average of 30 people died
from adrenal failure every year from 2001 to 2007. Four per cent of these
deaths were in children and teenagers, 9% in adults aged 20 – 39, 12% in
adults aged 40 – 59, 14% in adults in their 60s, 23% in adults in their
70s, and 38% in adults aged 80 or over.

As the case scenario offered by Vaidya, Chakera and Dick illustrates,
most adult patients with adrenal failure experience a lengthy and
debilitating illness before they are diagnosed. Many will have their
symptoms attributed to other illnesses, including psychiatric disorders.
Almost all will make repeated visits to their GP with a variety of non-
specific symptoms, in which overwhelming fatigue is the common
denominator. So most deaths from undiagnosed adrenal failure could,
arguably, be avoided through greater medical awareness of this rare

To assist GPs in the early detection of adrenal failure, the
Addison’s Disease Self-Help Group’s (ADSHG) Clinical Advisory Panel has
recently published a free guide 'Diagnosing Addison's: a guide for GPs'.
It describes the investigations that can be readily conducted in primary
care, and lists those symptoms which should act as a warning sign that
urgent referral to an endocrine specialist is advisable. You can read
these GP guidelines on the ADSHG website at along with
other free guides for GPs, surgeons, paramedics and other medical

Competing interests:
None declared

Competing interests: No competing interests

24 July 2009
Katherine G White
Les Christian, Nick Willson (trustees)
Addison's Disease Self-Help Group