EDITOR--Hilditch was diagnosed as having Addison's disease 40 years ago, when blood tests were more expensive and less frequently used for general screening than they are now. Her experience that the disease was not diagnosed until she was near death is, however, still common to many patients today and prompts the remark that "Getting diagnosed is the hardest part of this disease."
Early detection of Addison's disease is not easy: non-specific symptoms and fatigue may be overlaid by signs of depression (as is also the case with hypothyroidism). Some patients never develop the full classical triad of hyperpigmentation, hypotension, and hyponatraemia. The nature of the disease also means that patients who have struggled with subclinical symptoms for years as their adrenal function deteriorates suddenly become vulnerable to a crisis when they meet flu or another illness which they no longer have the adrenal reserves to combat. Some patients report having been admitted to hospital with a crisis more than once before their disease is diagnosed.
In some cases, the reluctance of medical practitioners to consider an uncommon cause of disease remains a factor in late diagnosis. It is only four years since a Lesson of the Week in the BMJ documented the deaths of two young patients whose Addison's disease was not diagnosed until necropsy. The first of these deaths took place in hospital; simple screening tests had raised Addison's disease as a possibility but were not acted on.
Addison's disease is relatively cheap and simple to treat. Our hope is that, by raising awareness of the condition, patients like Hilditch do not have to live with poor and deteriorating health until such time as an Addisonian crisis requiring admission to hospital prompts diagnosis.
Sarah Baker editorial director Concise Business To Business Information, Cheltenham GL54 5HD
Deana Kenward coordinator UK Addison's Disease Self-Help Group, 21 George Street, Guildford GU1 4NP
Katherine G White human resources consultant 97 Leith Mansions, Grantully Road, London W9 1LJ firstname.lastname@example.org
On behalf of the UK Addison's Disease Self-Help Group.
 Hilditch K. My Addison's disease. BMJ 2000;321:645. (9 September.)
 Brosnan CM, Gowing NFC. Lesson of the Week: Addison's disease. BMJ 1996;312:1085-7.
COPYRIGHT 2001 British Medical Association
COPYRIGHT 2001 Gale Group