Addison’s disease

Published on 02/04/2015 by admin

Filed under Internal Medicine

Last modified 02/04/2015

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144 Addison’s disease

Instruction

Look at this patient, who presented with weakness, loss of appetite and weight loss.

Salient features

History

• Dizziness, syncope

• Skin pigmentation (ask if the patient has been sitting in the sun)

• Ask questions regarding fatigue, weakness, apathy, anorexia, nausea, vomiting, weight loss and abdominal pain

• Depression.

Examination

• The striking abnormality is hyperpigmentation.

Proceed as follows:

• Examine for hyperpigmentation, typically localized to palmar creases and knuckles:

• Hand: compare the creases with your own
• Mouth and lips for pigmentation
• Areas not usually covered by clothing: nipples, areas irritated by belts, straps, collars or rings
• Look for vitiligo.

• Tell the examiner that you would like to investigate as follows:

• BP, in particular for postural hypotension
• Looking for sparse axillary and pubic hair
• The abdomen for adrenal scar (if the scar is pigmented, think of Nelson syndrome and examine field defects).

• If you suspect Addison’s disease, tell the examiner that you would like to do a short tetracosactrin test (synacthen test).

Diagnosis

This patient has postural hypotension, marked hyperpigmentation and sparse axillary hair (lesion) caused by autoimmune Addison’s disease (aetiology). The patient has marked hypoadrenalism (functional status).

Questions

What is the size of the heart in Addison’s deficiency?

The heart is small.

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