Dear Alia,

yes, of, course, and not only in secondary adrenal insufficiency. Symptoms can be quite unspecific for a long time including the classical ones of fatigue, weight loss, anorexia and salt cravings. Hypoglycaemia and resistant hypotension would be a feature of an adrenal crisis, often set off by stressors like intercurrent illness, medications, or steroid withdrawal.

You will find a some references (including to Addison's original report) in this brief review article:

Neary A, Nieman L. Adrenal Insufficiency- etiology, diagnosis and treatment. Curr Opin Endocrinol Diabetes Obes. 2010 Jun; 17(3): 217–223.

Best wishes,

Immo

Got a link to the article :

http://www.ncbi.nlm.nih.gov/pmc/articles/PMC2928659/

Dear Dr Weichert,

Thanks a lot for your answer. 

I concur with the answers already posted and will simply add that the clinical picture depends on how adrenally-insufficiant one is; i.e., what the level of cortisol is under basal (resting) conditions and what it rises to under stressful ones.  Some Addisonian patients can survive for many years with low, but not absent, cortisol levels until they are faced with stressful situations, when their insufficiency is "uncovered" for the first time.  They may have a low-normal BP and somewhat low blood glucose values but are essentially asymptomatic like other people without adrenal insufficiency.

Thank you.

Can a hypertensive, diabetic patient with high blood pressure and blood glucose levels have adrenal insufficiency?

Yes Sir, due to enormous use of steroids: oral, inhaled, topical, or even intra-articular  depending on potency and duration. Adrenal suppression that usually happen without hypotension can happen, adrenal insufficiency then develop at times of stress.

Yes , in secondary adrenal insufficiency , RAAS axis is still working so there may be no hypotension, another example is CAH due to 11 Hydroxylase deficiency in which the child has hypertension instead of hypotension, lastly I agree with pervious comments , presentation with hypoglycemia and hypotension may be late depending on Cortisol level and whether the patient is under stressors such as intercurrent illnesses , or sudden steroid treatment withdrawal.