Manifestations include fatigue, weakness, anorexia, nausea and vomiting, weight loss, abdominal pain, cutaneous and mucosal pigmentation, salt craving, hypotension (especially orthostatic), and, occasionally, hypoglycemia. Routine laboratory parameters may be normal, but typically serum Na is reduced and serum K increased. Extracellular fluid depletion accentuates hypotension. In secondary adrenal insufficiency, pigmentation is diminished and serum potassium is not elevated. Serum Na tends to be low because of hemodilution stemming from excess vasopressin secreted in the setting of cortisol deficiency.