Addison's disease results from a decrease in function of the cortex of the adrenal gland, and the loss of its principal hormone, cortisol.

There are primary and secondary types of the condition:

Early features include: weight loss, hypotension, anorexia, progressive weakness, and fatigue. In primary forms, skin pigmentation results in a bronze appearance, and black freckles appear over the head and neck. However, the bronze pigmentation may not be present in primary forms that occur rapidly. Dehydration, hyponatremia, and hyperkalemia may lead to profound shock.

Initial tests may show hyponatremia and hyperkalemia. Upon the administration of an adrenocorticotropic hormone (ACTH) stimulation test, failure of the plasma cortisol to increase and failure of the urine to excrete cortisol demonstrates adrenal insufficiency. A positive response to ACTH demonstrates a functioning adrenal gland and indicates probable pituitary disease.

All patients with decreased adrenal function must have corticosteroid replacement with cortisone or hydrocortisone for life. Some patients may require mineralocorticoids. A delay in starting therapy could lead to death.

Patients who receive proper treatment have an excellent prognosis. Those that require mineralocorticoids may, as a result of their use, experience hypokalemia, cardiac enlargement, and even congestive heart failure (CHF).

• Consider service connection on a presumptive basis as a chronic condition (38 CFR §3.307; §3.309 (a)).

• An Addisonian “crisis” consists of the rapid onset of peripheral vascular collapse (with acute hypotension and shock), with findings that may include: anorexia; nausea; vomiting; dehydration; profound weakness; pain in abdomen, legs, and back; fever; apathy, and depressed mentation with possible progression to coma, renal shutdown, and death.

• An Addisonian “episode,” for VA purposes, is a less acute and less severe event than an Addisonian crisis and may consist of anorexia, nausea, vomiting, diarrhea, dehydration, weakness, malaise, orthostatic hypotension, or hypoglycemia, but no peripheral vascular collapse.

• Tuberculous Addison's disease will be evaluated as active or inactive tuberculosis. If inactive, these evaluations are not to be combined with the graduated ratings of 50 percent or 30 percent for non-pulmonary tuberculosis specified under § 4.88b. Assign the higher rating.