Endocrine & metabolic · UKMLA & AKT
Adrenal insufficiency
A free high-yield preview for the UKMLA Applied Knowledge Test, covering how to recognise this condition. The full SA Note notes add investigations, management and complications, with practice questions on this topic.
Key high-yield points
- Fatigue and weakness - most common presenting complaint; profound and disproportionate
- Hyperpigmentation - primary disease only; palmar creases, buccal mucosa, scars, pressure areas - driven by elevated MSH (shares POMC precursor with ACTH)
- Postural hypotension - aldosterone deficiency → sodium/volume depletion
- Hyponatraemia, hyperkalaemia, non-anion-gap metabolic acidosis - primary disease only (aldosterone loss)
- Hypoglycaemia - cortisol deficiency impairs gluconeogenesis
- Nausea, vomiting, weight loss, salt craving, reduced axillary/pubic hair in women
Hyperpigmentation is the key discriminator: present in primary (high ACTH → high MSH), absent in secondary (low ACTH). A 'tanned' patient who has not been in the sun = Addison's disease until proven otherwise.
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