Addison's Disease and Its Dermatological and Endocrinological Involvement

Abstract

Introduction: Addison’s disease has a distinctive skin–mucosal phenotype enabling early detection and requiring integrated care pathways. Objective: To synthesize evidence on dermatologic and endocrinologic manifestations, diagnosis, replacement therapy, and crisis prevention. Results and discussion: Twelve recent publications and one clinical guideline concur that diffuse hyperpigmentation (skin folds and oral mucosa) often precedes systemic symptoms; recognition by dermatology/dentistry shortens time to diagnosis. Confirmation relies on low morning cortisol with elevated ACTH and the short ACTH test with updated cutoffs, plus aldosterone/renin assessment and anti-21-hydroxylase antibodies for autoimmune Addison’s. Split-dose hydrocortisone ± fludrocortisone, together with “sick-day rules,” self-injection training, and an emergency kit, reduces adrenal crises and admissions; fast-track emergency protocols improve safety. Screening for polyglandular autoimmunity and routine PROMs support tailored management and address quality of life. Evidence gaps remain regarding DHEA, modified-release/circadian formulations, and preclinical risk algorithms. Conclusion: Early recognition from skin and mucosa, standardized diagnostic algorithms, patient education, and emergency protocols form the backbone of cost-effective, person-centered care.