HISTORY

• Facial appearance;
• Round and plethoric, acne, hirsutism, thinning of scalp hair. Oral thrush
• Weight gain;
• Truncal obesity, supraclavicular fat pads, buffalo hump.
• Skin changes;
• Thin fragile skin, purple striae, easy bruising, tinea versicolor,
pigmentations.
• Proximal muscle weakness.
• Mood disturbances.
• Loss of libido, impotence.
• Growth arrest in children's.
 Cont.
• Ask about back pain, examine the back for
kyphoscoliosis, and tenderness [osteoporosis]
Spinal fracture.
 History of steroid use and diseases treated
with [ bronchial asthma, SLE, Rheumatoid
arthritis].
 Check the blood pressure and test the urine
for sugar
 Adrenal insufficiency
• Symptoms, nonspecific like weakness, fatigue and
anorexia. GIT symptoms [nausea, vomiting,
abdominal pain and constipation. Weight loss.
• Symptoms of orthostatic hypotension [dizziness]
• Myalgia, arthralgia and salt craving.
• Psychiatric symptoms from mild cognitive
disorder to frank psychosis
• Steroid use [important].
 Signs
• Hyper pigmentation [skin, mouth and mucous
membranes, palmer creases [compare with
your own], recent scars, exposed area,
nipples, and areas irritated by belts, collars or
rings [pigmentation is not present in 30% of
primary adrenal insufficiency and absent in
hypopituitarism].
• Vitiligo
• Symptoms and signs of panhypopituitarism
 Notes
• The commonest cause is sudden steroid
withdrawal or failure to increase the dose in
stressful situation.
• Postural hypotension 20/10 drop in systolic
and diastolic blood pressure on standing.
 SLIDE NO(1)
1-Name this sign?
2- Give three differentials.