Unfortunately, because many of the symptoms of adrenocortical insufficiency are non-specific, such as tiredness or weakness, the diagnosis of Addison's disease is often delayed until the patient is critically ill. It is therefore important to recognise that the presentation is most readily classified on the basis of the features associated with acute adrenocortical insufficiency and those seen in patients with the chronic condition.
In the acute stage, the most obvious feature is shock. Most patients presenting with an acute adrenocortical crisis will be known to have the primary adrenal condition; the crisis will often have been precipitated by failure to take, or to absorb, glucocorticoids used in the treatment (for example when acute gastroenteritis occurs), or because the glucocorticoid dose was not increased to cover intercurrent stress (e.g. in pneumonia or major surgery).
