Addison's disease physical examination

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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.

Vitals

• Low blood pressure
• Orthostatic hypotension
• Fever

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.