Apart from its auto-immunologic aspects, Addison's disease generates little excitement these days. Its differential diagnosis is easy. Lack of response to cortical stimulation by exogenous corticotropin readily differentiates the disease from adrenal cortical insufficiency secondary to disorders at higher levels on the hypothalamic-pituitary-adrenal axis. And a history of corticoid or anticoagulant therapy clearly separates iatrogenic hypoadrenocorticism from the primary disease. The treatment is also simple. Glucocorticoids, mineralocorticoids, and occasionally androgenic steroids provide effective hormonal replacement.
But have the ease of differential diagnosis and the efficacy of therapy ensured prompt detection of the disease and the elimination of its mortality? According to an epidemiologic study by Mason et al,1 they have not. The study, conducted at the North East Metropolitan Regional Hospital Board of London, identified 82 patients with Addison's disease in a population of 3,200,000. A five-year follow-up of 74 of these patients in the age group 25-69 years