Addison's disease

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.

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

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.

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

Muscle wasting may occur in gonadotropin and glucocorticoid deficiency.

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

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

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.

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

Specifically seek nodules or signs suggestive of possible malignancy.

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