endocrine and metabolic disorders
Addison Disease
Symptoms and Signs of Addison Disease
Weakness, fatigue, and orthostatic hypotension are early symptoms and signs of Addison disease. Hyperpigmentation is characterized by diffuse tanning of exposed and, to a lesser extent, unexposed portions of the body, especially on pressure points (bony prominences), skin folds, scars, and extensor surfaces. Black freckles are common on the forehead, face, neck, and shoulders. Bluish black discolorations of the areolae and mucous membranes of the lips, mouth, rectum, and vagina occur. Anorexia, nausea, vomiting, and diarrhea often occur. Decreased tolerance to cold, with hypometabolism, may be noted. Dizziness and syncope may occur. The gradual onset and nonspecific nature of early symptoms often lead to an incorrect initial diagnosis of neurosis. Weight loss, dehydration, and hypotension are characteristic of the later stages of Addison disease. Adrenal crisis is characterized by Profound asthenia (weakness) Severe pain in the abdomen, lower back, or legs Peripheral vascular collapse Renal shutdown with azotemia Body temperature may be low, although severe fever often occurs, particularly when crisis is precipitated by acute infection. A significant number of patients with partial loss of adrenal function (limited adrenocortical reserve) appear well but experience adrenal crisis when under physiologic stress (eg, surgery, infection, burns, critical illness). Shock and fever may be the only signs. 