Clinical Case Database / Category: Patient Management

Addison's disease: An endocrine emergency

Publication details

Dr Ross Hamblin, Dr Masud Haq, Dr Dennis Barnes
Foundation Years Journal, volume 8, issue 5, p.10 (123Doc Education, London, May 2014)


Primary hypoadrenalism, also known as ‘Addison’s disease’ is a rare condition, currently affecting around 8,400 individuals in the United Kingdom (1). Often insidious, it is potentially life-threatening if not recognised and treated promptly. This article aims to highlight the diagnosis, investigation and management of Addison’s disease by focussing on a patient who presented acutely to our Emergency Department.

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Dr Ross Hamblin

FY1 Doctor, Diabetes/Endocrine Department, The Tunbridge Wells Hospital, Tonbridge Road, Pembury, Kent, TN2 4QJ.

Dr Masud Haq

Consultant Physician, Diabetes/Endocrine Department, The Tunbridge Wells Hospital, Tonbridge Road, Pembury, Kent, TN2 4QJ.

Dr Dennis Barnes

Consultant Physician, Diabetes/Endocrine Department, The Tunbridge Wells Hospital, Tonbridge Road, Pembury, Kent, TN2 4QJ.


1. Wass J, Howlett T, Arlt W, et al. Diagnosing Addison’s: a guide for GPs. Addison’s Disease Self Help Group. 2009.
2. Zelissen PM, Bast EJ, Croughs RJ. Associated autoimmunity in Addison’s disease. J Autoimmun 1995, 8(1):121-30.
3. Erichsen MM, Løvås K, Skinningsrud B, et al. Clinical, immunological, and genetic features of
autoimmune primary adrenal insufficiency: observations from a Norwegian registry. J Clin Endocrinol Metab 2009, 94:4882-90.
4. Sonino N. The use of ketoconazole as an inhibitor of steroid production. N Engl J Med 1987, 317:812-8.
5. Riedl M, Maier C, Zettinig G, et al. Long term control of hypercortisolism with fluconazole: case report in vitro studies. Eur J Endocrinol 2006, 154:519-24.
6. Liddle GW, Island D, Lance EM, Harris AP. Alterations of adrenal steroid patterns in man resulting from treatment with a chemical inhibitor of 11 beta-hydroxylation. J Clin Endocrinol Metab 1958, 18:906-12
7. Addison’s disease. NICE CKS, September 2010.


Conflict Of Interest

The Journal requires that authors disclose any potential conflict of interest that they may have. This is clearly stated in the Journal’s published “Guidelines for Authors”. The Journal follows the Guidelines against Conflict of Interest published in the Uniform Requirements for Manuscripts Submitted to Biomedical Journals (

Financial Statement

The authors of this article have not been paid. The Journal is financed by subscriptions and advertising. The Journal does not receive money from any other sources. The decision to accept or refuse this article for publication was free from financial considerations and was solely the responsibility of the Editorial Panel and Editor-in-Chief.

Patient Consent statement

All pictures and investigations shown in this article are shown with the patients’ consent. We require Authors to maintain patients’ anonymity and to obtain consent to report investigations and pictures involving human subjects when anonymity may be compromised. The Journal follows the Guidelines of the Uniform Requirements for Manuscripts ( The Journal requires in its Guidelines for Authors a statement from Authors that “the subject gave informed consent”.

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When reporting experiments on human subjects, the Journal requires authors to indicate whether the procedures followed were in accordance with the ethical standards of the responsible committee on human experimentation (institutional and national) and with the HelsinkiDeclaration of 1975, as revised in 2008.

About the Clinical Cases Database

T​he Foundation Years Clinical Cases Database is​ a selection of 600 peer-reviewed clinical cases in the field of patient safety and clinical practice, specifically focused on the clinical information needs of junior doctors, based around the Foundation Year Curriculum programme (MMC). The cases have been chosen to align with the Foundation Year Curriculum.

The database is fully searchable, or can be browsed by medical specialty. Abstracts can be read free of charge, however a subscription is required in order to read the complete cases.