Addison Disease

Station 5
By dr : sadek al-rokh

Senario:
Loss of weight
Dizzy spells
Hyperpigmentation
Hyperpigmentation
DD :
1.
Racial Familial
2.
Addison
3.
Nilson `s syndrome
4.
Cushing disease
5.
Heamochromatosis (primary ,
secondary )
6.
Porphyria catunia tarda
7.
CLD CKD
8.
Drug induced ie Amiodarone
History
Onset , course, duration , progression , improving
and worsening factors .

 Any hx of tummy pain , yellowish discolouration of

the eye balls , surgical oprations , bl transfusion
( CLD )
Any hx of loss of libido , DM , SOB , leg swelling ,
joint pain ( haemochrmatosis )
Hx of recurrent bl transfusion ( 2ndry
haemochromatosis
Hx of kidney proplem , oligourea , eye puffiness
( CKD )
HX of weight gain , stretch marks , poximal
myopathy, oligomenorea ( cushing )
Hx of dizzy spells when getting up from supine or
setting position ( posural hypotension ) ( Addison )
Once u catched the diagnosis ask about other
symptoms of Addison ,
hyperpigmentation of the lining of oral cavity,
hx of loss of weight ( how much kg , for how long
), what about apetite ?
Hx of TB , OR HX of contact w TB patient .
Other autuimmune disease ie DM , skin
depigmentation (vetiligo) , areas of hair lost
( Alopecia) small joint pain of the hands (RA) ,
butterfly rash ans arthropathy (SLE) .

Social history:
Ptn job ?-- how much the symptoms do impaction
on his job & usual daily activity ? if do say :I am
sorry I will refer u to a social worker to solve this
problem for you ( very important
with whom ptn is living with?
Finintial support ?

Smoking & alcohol history.

Medical history: DM , HTN, Cardiac problem ,

Surgical operations

Family history:

similar problem or medical

disease.

Drug history:

what is your drug list ?

Examination
Hand : hyperpigmenred creases , pulse .
Oral cavity : by torch for
hyperpigmentaion .
Look to the back for any scars indicating
hx of adrenelectomy ( Nilson ).
Ask the examiner I want to check this
patient BP in supine and erect postion .