The role of your GP
Often, symptoms will develop slowly over time as the cortisol or other hormone levels gradually decrease. It is likely to be your GP that you visit to report the signs and symptoms of adrenal insufficiency: perhaps weight loss, extreme fatigue and nausea/vomiting.
As these symptoms can also be seen in other conditions, misdiagnosis is possible. Some people have reported being treated for depression or for an eating disorder, as doctors have misinterpreted individual symptoms.
Addison's disease (primary adrenal insufficiency) may be more recognisable in people whose skin pigmentation changes (hyperpigmentation), but many GPs will not have come across it before due to its rarity.
One of the important aims of the ADSHG is to raise awareness of adrenal insufficiency and adrenal crisis with GPs, to achieve earlier diagnosis.
Where the patient is stable, the GP should assess for clinical signs, especially:
- Blood pressure sitting and standing. A 20 mmHg drop on standing indicates clear postural hypotension.
- Proximal myopathy or global muscle weakness (difficulty climbing stairs, getting up from a sitting/squatting position, or carrying weights, such as grocery shopping).
- Addison's disease: Patchy hyperpigmentation or, in Caucasians, unusual pigmentation in the palmar/wrist creases (not present in 20% of cases, depending on the patient’s natural level of melanocytes). Hyperpigmentation is typically most obvious in areas of increased friction, such as the oral mucosa, knuckles, elbows or waistline.
Once adrenal insufficiency is suspected, GPs will refer on to an endocrinologist, a doctor who specialises in treating hormone-related conditions. 
Whilst not everyone might identify as having a disability, people with Addison’s and adrenal insufficiency are covered by the definition of disability under the Equality Act 2010, or if you live in Northern Ireland, the Disability Discrimination Act 1995.