Adrenal insufficiency physical examination: Difference between revisions
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{{Adrenal insufficiency}} | {{Adrenal insufficiency}} | ||
{{CMG}}; {{AE}} | {{CMG}}; {{AE}} {{Ayeesha}} | ||
==Overview== | ==Overview== | ||
Patients with [ | Patients with [[adrenal insufficiency]] usually appear [[dehydrated]] and weak. Physical examination of patients with [[primary adrenal insufficiency]] is usually remarkable for hyperpigmentation of skin. | ||
==Physical Examination== | ==Physical Examination== | ||
Physical examination of patients with [ | Physical examination of patients with [[primary adrenal insufficiency]] is usually remarkable for hyperpigmentation of skin. <ref name="LeeCho2017">{{cite journal|last1=Lee|first1=Ye Yeon|last2=Cho|first2=Nan Hee|last3=Lee|first3=Jong Won|last4=Kim|first4=Nam Kyung|last5=Kim|first5=Hye Soon|last6=Kim|first6=Mi-Kyung|title=Clinical Characteristics of Patients with Adrenal Insufficiency in a General Hospital|journal=Endocrinology and Metabolism|volume=32|issue=1|year=2017|pages=83|issn=2093-596X|doi=10.3803/EnM.2017.32.1.83}}</ref> | ||
===Appearance of the Patient=== | ===Appearance of the Patient=== | ||
*Patients with [ | *Patients with [[adrenal insufficiency]] usually appear [[dehydrated]] or weak. | ||
===Vital Signs=== | ===Vital Signs=== | ||
| Line 49: | Line 25: | ||
*Loss of axillary and pubic hair in women with [[primary adrenal insufficiency]] | *Loss of axillary and pubic hair in women with [[primary adrenal insufficiency]] | ||
*Horizontal bands of [[hyperpigmentation]] on the nails. | *Horizontal bands of [[hyperpigmentation]] on the nails. | ||
Following image shows mucosal hyperpigmentation in Addison's disease: | |||
[[Image:Addisons hyperpigmentation.jpg|thumb|center|500px|Mucosal hyperpigmentation - By FlatOut - Dermatology Online Journal http://dermatology.cdlib.org/, CC0, https://commons.wikimedia.org/w/index.php?curid=25847348]] | |||
===HEENT=== | ===HEENT=== | ||
| Line 60: | Line 40: | ||
===Heart=== | ===Heart=== | ||
* Cardiovascular examination of patients with [ | * Cardiovascular examination of patients with [[adrenal insufficiency]] is usually normal. | ||
===Abdomen=== | ===Abdomen=== | ||
*[[Abdominal tenderness]] and [[guarding]] can be present in [[adrenal crisis]] <ref>https://www.amjmed.com/article/S0002-9343(15)00827-X/pdf</ref> | |||
*[[Abdominal | |||
===Back=== | ===Back=== | ||
* Back examination of patients with [ | * Back examination of patients with [[adrenal insufficiency]] is usually normal. | ||
===Genitourinary=== | ===Genitourinary=== | ||
* Genitourinary examination of patients with [ | * Genitourinary examination of patients with [[adrenal insufficiency]] is usually normal. | ||
===Neuromuscular=== | ===Neuromuscular=== | ||
* | * Altered mental status maybe seen in patients with [[adrenal crisis]] <ref>https://www.amjmed.com/article/S0002-9343(15)00827-X/pdf</ref> | ||
===Extremities=== | ===Extremities=== | ||
* Extremities examination of patients with [ | * Extremities examination of patients with [[adrenal insufficiency]] is usually normal. | ||
==References== | ==References== | ||
Latest revision as of 18:13, 7 December 2020
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Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]; Associate Editor(s)-in-Chief: Ayeesha Kattubadi, M.B.B.S[2]
Overview
Patients with adrenal insufficiency usually appear dehydrated and weak. Physical examination of patients with primary adrenal insufficiency is usually remarkable for hyperpigmentation of skin.
Physical Examination
Physical examination of patients with primary adrenal insufficiency is usually remarkable for hyperpigmentation of skin. [1]
Appearance of the Patient
- Patients with adrenal insufficiency usually appear dehydrated or weak.
Vital Signs
- Fever maybe present in adrenal insufficiency. [2]
- Low blood pressure with normal pulse pressure is seen, especially in [[primary adrenal insufficiency due to mineralocorticoid deficiency.
- Adrenal crisis presents with hypotension, tachycardia, hypovolemia. [3]
Skin
- Skin examination of patients with primary adrenal insufficiency includes: [4]
- Hyperpigmentation, commonly affecting the palmar creases, perineum, axilla, and areola. It is most prominent in areas exposed to trauma, pressure and sun.
- Mucosal hyperpigmentation commonly effects buccal, gingival, tongue, vermillion border of lips. [5]
- Loss of axillary and pubic hair in women with primary adrenal insufficiency
- Horizontal bands of hyperpigmentation on the nails.
Following image shows mucosal hyperpigmentation in Addison's disease:
HEENT
- HEENT examination of patients with adrenal insufficiency is usually normal.
Neck
- Neck examination of patients with adrenal insufficiency is usually normal.
Lungs
- Pulmonary examination of patients with adrenal insufficiency is usually normal.
Heart
- Cardiovascular examination of patients with adrenal insufficiency is usually normal.
Abdomen
- Abdominal tenderness and guarding can be present in adrenal crisis [6]
Back
- Back examination of patients with adrenal insufficiency is usually normal.
Genitourinary
- Genitourinary examination of patients with adrenal insufficiency is usually normal.
Neuromuscular
- Altered mental status maybe seen in patients with adrenal crisis [7]
Extremities
- Extremities examination of patients with adrenal insufficiency is usually normal.
References
- ↑ Lee, Ye Yeon; Cho, Nan Hee; Lee, Jong Won; Kim, Nam Kyung; Kim, Hye Soon; Kim, Mi-Kyung (2017). "Clinical Characteristics of Patients with Adrenal Insufficiency in a General Hospital". Endocrinology and Metabolism. 32 (1): 83. doi:10.3803/EnM.2017.32.1.83. ISSN 2093-596X.
- ↑ "StatPearls". 2020. PMID 28722862.
- ↑ Pazderska, Agnieszka; Pearce, Simon HS (2017). "Adrenal insufficiency – recognition and management". Clinical Medicine. 17 (3): 258–262. doi:10.7861/clinmedicine.17-3-258. ISSN 1470-2118.
- ↑ Lause M, Kamboj A, Fernandez Faith E (2017). "Dermatologic manifestations of endocrine disorders". Transl Pediatr. 6 (4): 300–312. doi:10.21037/tp.2017.09.08. PMC 5682371. PMID 29184811.
- ↑ Sarkar, SoumyaBrata; Sarkar, Subrata; Ghosh, Supratim; Bandyopadhyay, Subhankar (2012). "Addison′s disease". Contemporary Clinical Dentistry. 3 (4): 484. doi:10.4103/0976-237X.107450. ISSN 0976-237X.
- ↑ https://www.amjmed.com/article/S0002-9343(15)00827-X/pdf
- ↑ https://www.amjmed.com/article/S0002-9343(15)00827-X/pdf