The symptoms of adrenal insufficiency usually begin gradually. The most common symptoms are
•chronic, worsening fatigue
•loss of appetite
Other symptoms can include
•low blood pressure that falls further when standing, causing dizziness or fainting
•irritability and depression
•a craving for salty foods due to salt loss
•hypoglycemia, or low blood glucose
•in women, irregular or absent menstrual periods
Hyperpigmentation, or darkening of the skin, can occur in Addison’s disease but not in secondary adrenal insufficiency. This darkening is most visible on scars; skin folds; pressure points such as the elbows, knees, knuckles, and toes; lips; and mucous membranes such as the lining of the cheek.
Because the symptoms progress slowly, they are often ignored until a stressful event like an illness or accident causes them to worsen. Sudden, severe worsening of symptoms is called an Addisonian crisis, or acute adrenal insufficiency. In most cases, symptoms of adrenal insufficiency become serious enough that people seek medical treatment before a crisis occurs. However, sometimes symptoms first appear during an Addisonian crisis.
Symptoms of an Addisonian or “adrenal” crisis include
•sudden, penetrating pain in the lower back, abdomen, or legs
•severe vomiting and diarrhea
•low blood pressure
•loss of consciousness
If not treated, an Addisonian crisis can be fatal.