| 1. Genetic risk | None | HLA-B8, -DR3, and -DR4 genes confer risk |
| 2. Precipitating event starts antiadrenal autoimmunity | None | Possible environmental trigger |
| 3. 21-hydroxylase antibodies present | None | Antibodies appear before disease onset in 90% of cases |
| 4. Metabolic decompensation | Fatigue, anorexia, nausea, hyperpigmentation | Increased ACTH and decreased 8 a.m. cortisol levels; high clinical suspicion needed for diagnosis |
| 5. Decreased response to ACTH stimulation | Hypotension and shock (addisonian crisis) | Severe symptoms can be life-threatening |
