Addison's disease

Adrenal failure causing glucocorticoid and mineralocorticoid insufficiency. The diagnosis typically refers to auto-immune destruction of the gland, and is confirmed using a Synacthen test.

General examination

To diagnose Addison's disease a detailed and full general examination is mandatory in the initial assessment of a patient, with particular reference to possible malignancy.

Blood pressure

A postural drop in BP may be found in glucocorticoid and mineralocorticoid deficiency.

Skin and hair

Deep pigmentation or tanning of the skin is typical in Addison’s disease. Palmar creases, surgical scars and the inside of the mouth (buccal pigmentation) should all be inspected.

Fine wrinkling of pale skin occurs in hypopituitarism.

Pallor may also occur with anaemia.

Doughy pallid 'myxoedematous' skin may be seen with loss of thyroid function.

Body habitus, height, weight, waist hip ratio and BMI

Weight loss occurs in glucocorticoid deficiency of any cause. Weight loss also occurs in malignancy and thyroid dysfunction.

Musculature

Muscle wasting may occur in gonadotropin and glucocorticoid deficiency.

Proximal myopathy may occur and slow relaxing reflexes may occur with loss of thyroid function.

Gonadal status

Signs of hypogonadism may indicate pituitary disease though primary gonadal failure may be linked with auto-immune Addison's.

Thyroid status

Examine for signs of either under or over activity of the thyroid. Signs of hypothyroidism may indicate pituitary disease though auto-immune hypothyroidism or hyperthyroidism may be linked with Addison's.

Lymph nodes

Thorough examination for lymphadenopathy is important in seeking evidence of underlying malignancy.

Breast and thyroid examination

Specifically seek nodules or signs suggestive of possible malignancy.

Digital rectal examination

Consider this in all patients especially in the context of altered bowel habit for possible underlying malignancy.