Addison disease (primary adrenocortical insufficiency) is characterized by a deficiency in all three types of adrenal steroids (ie, glucocorticoids, androgens, mineralocorticoids), most commonly caused by an autoimmune response. Corticosteroid therapy (eg, hydrocortisone, dexamethasone, prednisone) is the primary treatment for Addison disease. Long-term use of corticosteroids can cause immunosuppression, and the anti- inflammatory effects may also mask signs of infection (eg, inflammation, redness, tenderness, heat, fever, edema). Signs and symptoms of infection (eg, low-grade fever) should be reported to the health care provider immediately as infection can develop quickly and spread rapidly (Option 2).

In addition, physiological stress such as infection can trigger Addisonian crisis, a life-threatening complication of Addison disease that would require an increase in the corticosteroid dose.

(Options 1, 3, and 4) Side effects of long-term corticosteroid therapy mimic the signs and symptoms of Cushing syndrome, including buffalo hump, moon-shaped face, and hypokalemia. Increased weight, blood pressure, and blood glucose levels can also occur; however, these effects are not as life-threatening as infection.