EPIDEMIOLOGICAL AND CLINICAL PICTURE OF ADDISON'S DISEASE

Abstract

Population studies have been carried out " to complete the clinical picture" of Addison's disease. A prevalence-count on Jan. 1, 1960, in the North East Metropolitan Regional Hospital Board area identified eighty-two patients of all ages in a population of 3,200,000; in the age range 25-69 years Addison's disease affected thirty-nine per million, twelve with tuberculous and twenty-seven with non-tuberculous disease. Tuberculous disease was commoner in men, non-tuberculous in women. On follow-up, five years later, only one of the seventy-four patients aged 25-69 had died of Addison's disease; there were, however, eleven other deaths from the disease in the region during this period, all of them people who first presented after the prevalence-count had been completed. A study of deaths from Addison's disease in the areas of all four metropolitan hospital boards showed an annual death-rate at 25-69 of 1·4 per million; of the fifty-six deaths at these ages twenty-eight were due to tuberculous and twenty-eight to non-tuberculous disease. Thus a community study of Addison's disease produces a very different picture of its natural history from that presenting in hospital patients. There are at least two clinical courses. The " chronic " course develops more commonly in women and is usually due to non-tuberculous disease; the patients have a good prognosis and very low fatality-rate, probably because they are under regular medical care. Addison's disease following the " acute " course is due to tuberculosis and atrophy of the glands about equally, and similar numbers of men and women are affected. The onset is sudden and the course rapid with a poor prognosis and a high fatality-rate; death is often sudden and unexpected, and the diagnosis frequently made only at coroner's post-mortem. These patients often also have major social and psychiatric problems. The Registrar General's mortality figures showing nearly four deaths from non-tuberculous to one from tuberculous Addison's disease substantially underestimate the tuberculous form; death certificates are inaccurately completed for this disease even when necropsy findings are available.