Addison's disease physical examination: Difference between revisions

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Latest revision as of 16:43, 18 September 2017

Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1] ; Associate Editor(s)-in-Chief: Aditya Ganti M.B.B.S. [2]

Overview

In many cases, Addison's disease is only recognized when the patient presents with an acute crisis precipitated by a stressful illness or situation. Acute adrenal insufficiency should be considered in patients presenting with abdominal pain, nausea, diarrhea, hypotension, and fever. Patients with acute Addison's disease usually appear dehydrated and lethargic. Physical examination of patients with Addison's disease is usually remarkable for hypotension, hyperpigmentation of the skin, and muscle weakness.

Physical Examination

Appearance

The patient may be dehydrated and lethargic.^[1]

Vitals

Skin

Pigmented skin and mucous membranes - darkening (hyperpigmentation) of the skin, including areas not exposed to the sun; characteristic sites are skin creases (e.g. of the hands), nipples, and the inside of the cheek (buccal mucosa), also old scars may darken.
Vitiligo may be present.
Absence of axillary and pubic hair in females as a result of loss of adrenal androgens.
Pallor may be present.

Neck

Goiter may be present.

Extremities

Weakness

Neurologic

Confusion may be present
Seizures may be present.

References

↑ Sarkar SB, Sarkar S, Ghosh S, Bandyopadhyay S (2012). "Addison's disease". Contemp Clin Dent. 3 (4): 484–6. doi:10.4103/0976-237X.107450. PMC 3636818. PMID 23633816.

Template:WH Template:WS

[pmid23633816-1] Sarkar SB, Sarkar S, Ghosh S, Bandyopadhyay S (2012). "Addison's disease". Contemp Clin Dent. 3 (4): 484–6. doi:10.4103/0976-237X.107450. PMC 3636818. PMID 23633816.

[1]

@@ Line 2: / Line 2: @@
 {{Addison's disease}}
-{{CMG}}
+{{CMG}} ; {{AE}} {{ADG}}
 ==Overview==
+In many cases, Addison's disease is only recognized when the patient presents with an acute crisis precipitated by a stressful illness or situation. Acute adrenal insufficiency should be considered in patients presenting with [[abdominal pain]], [[nausea]], [[diarrhea]], [[hypotension]], and [[fever]]. Patients with acute Addison's disease usually appear [[dehydrated]] and [[lethargic]]. Physical examination of patients with Addison's disease is usually remarkable for [[hypotension]], [[hyperpigmentation]] of the skin, and [[muscle weakness]].
 ==Physical Examination==
+===Appearance===
+The patient may be [[dehydrated]] and [[lethargic]].<ref name="pmid23633816">{{cite journal |vauthors=Sarkar SB, Sarkar S, Ghosh S, Bandyopadhyay S |title=Addison's disease |journal=Contemp Clin Dent |volume=3 |issue=4 |pages=484–6 |year=2012 |pmid=23633816 |pmc=3636818 |doi=10.4103/0976-237X.107450 |url=}}</ref>
+===Vitals===
+* [[Hypotension|Low blood pressure]]
+* [[Orthostatic hypotension]]
+* [[Fever]]
 ===Skin===
-* Pigmented skin and mucous membranes.
+* Pigmented skin and mucous membranes - darkening ([[hyperpigmentation]]) of the skin, including areas not exposed to the sun; characteristic sites are skin creases (e.g. of the hands), nipples, and the inside of the cheek (buccal mucosa), also old scars may darken.
 * [[Vitiligo]] may be present.
+* Absence of axillary and pubic hair in females as a result of loss of adrenal [[androgens]].
+* [[Pallor]] may be present.
-On examination, the following may be noticed:<ref name=Ten/>
+===Neck===
-* [[Hypotension|Low blood pressure]] that falls further when standing ([[orthostatic hypotension]])
+* [[Goiter]] may be present.
-* Darkening (hyperpigmentation) of the skin, including areas not exposed to the sun; characteristic sites are skin creases (e.g. of the hands), nipples, and the inside of the cheek (buccal mucosa), also old scars may darken.
-* Signs of conditions that often occur together with Addison's: [[goiter]] and [[vitiligo]]
-Because the symptoms progress slowly, they are usually ignored until a stressful event like an illness or an accident causes them to become worse. This is called an addisonian crisis, or acute adrenal insufficiency. In most cases, symptoms are severe enough that patients seek medical treatment before a crisis occurs. However, in about 25 percent of patients, symptoms first appear during an addisonian crisis.
-=== Addisonian crisis ===
-An "Addisonian crisis" or "adrenal crisis" is a constellation of symptoms that indicate severe adrenal insufficiency. This may be the result of either previously undiagnosed Addison's disease, a disease process suddenly affecting adrenal function (such as [[adrenal hemorrhage]]), or an intercurrent problem (e.g. infection, trauma) in the setting of known Addison's disease. Additionally, this situation may develop in those on long-term oral [[glucocorticoid]]s who have suddenly ceased taking their medication.  It is also a concern in the setting of [[myxedema coma]]; [[thyroxine]] given in that setting without [[glucocorticoid]]s may precipitate a crisis.
-Untreated, an Addisonian crisis can be fatal. It is a [[medical emergency]], usually requiring hospitalization. Characteristic symptoms are:<ref>[http://www.endocrine.niddk.nih.gov/pubs/addison/addison.htm#symptoms Addison's Disease] National Endocrine and Metabolic Diseases Information Service. Retrieved on 26 October, 2007.</ref>
-* Sudden penetrating pain in the legs, lower back or abdomen
-* Severe [[vomiting]] and [[diarrhea]], resulting in [[dehydration]]
-* [[Hypotension|Low blood pressure]]
-* [[Fainting|Loss of consciousness/Syncope]]
-* [[Hypoglycemia]]
-* [[Confusion]], [[psychosis]]
-* [[Seizure|Convulsions]]
+===Extremities===
+* [[Weakness]]
+===Neurologic===
+* [[Confusion]] may be present
+* [[Seizures]] may be present.
 ==References==
-{{reflist|2}}
+{{Reflist|2}}
+[[Category:Endocrinology]]
+[[Category:Disease]]
+[[Category:Medical emergencies]]
+[[Category:Emergency medicine]]
+[[Category:Intensive care medicine]]
+[[Category:Needs overview]]
 {{WH}}
 {{WS}}