Secondary adrenal insufficiency physical examination: Difference between revisions
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===Vital Signs=== | ===Vital Signs=== | ||
*Low-grade fever may be present | *Low-grade fever may be present | ||
*[[Tachycardia]] may be present | *[[Tachycardia]] may be present | ||
* | *Hypotension- less common<ref name="pmid3002680">{{cite journal |vauthors=Burke CW |title=Adrenocortical insufficiency |journal=Clin Endocrinol Metab |volume=14 |issue=4 |pages=947–76 |year=1985 |pmid=3002680 |doi= |url=}}</ref><ref name="pmid6276646">{{cite journal |vauthors=Stacpoole PW, Interlandi JW, Nicholson WE, Rabin D |title=Isolated ACTH deficiency: a heterogeneous disorder. Critical review and report of four new cases |journal=Medicine (Baltimore) |volume=61 |issue=1 |pages=13–24 |year=1982 |pmid=6276646 |doi= |url=}}</ref><ref name="pmid24503135">{{cite journal |vauthors=Charmandari E, Nicolaides NC, Chrousos GP |title=Adrenal insufficiency |journal=Lancet |volume=383 |issue=9935 |pages=2152–67 |year=2014 |pmid=24503135 |doi=10.1016/S0140-6736(13)61684-0 |url=}}</ref><ref name="pmid27271953">{{cite journal |vauthors=Cuesta M, Garrahy A, Slattery D, Gupta S, Hannon AM, Forde H, McGurren K, Sherlock M, Tormey W, Thompson CJ |title=The contribution of undiagnosed adrenal insufficiency to euvolaemic hyponatraemia: results of a large prospective single-centre study |journal=Clin. Endocrinol. (Oxf) |volume=85 |issue=6 |pages=836–844 |year=2016 |pmid=27271953 |doi=10.1111/cen.13128 |url=}}</ref> | ||
*No dehydration | |||
===Skin=== | ===Skin=== | ||
Revision as of 00:16, 10 October 2017
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Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]; Associate Editor(s)-in-Chief: Amandeep Singh M.D.[2]
Overview
Patients with secondary adrenal insufficiency usually appear weak or cushingoid (if the cause is glucocorticoids withdrawal). Physical examination of patients with secondary adrenal insufficiency is usually remarkable for cushingoid features like muscle weakness, buffalo hump. Hypotension may or may not be present. The absence of hyperpigmentation is the hallmark and a distinguishing feature of secondary adrenal insufficiency. Also, the presence of visual field defects like bitemporal hemianopsia indicates a pituitary tumor.
Physical Examination
Appearance of the Patient
- Patients with secondary adrenal insufficiency usually appear weak and fatigued.
- They may present with cushingoid features if there is any history of prolonged steroid intake.
Vital Signs
- Low-grade fever may be present
- Tachycardia may be present
- Hypotension- less common[1][2][3][4]
- No dehydration
Skin
- Pallor may be present
- Bruises may be present
- Unlike Addison's , there is no hyperpigmentation. Its one of the hallmark for differentiating them.
HEENT
- Extra-ocular movements may be abnormal
- Visual field defects can be seen such as bitemporal hemianopsia
Neck
Lungs
- Symmetric chest expansion
- Normal tactile fremitus
Heart
Abdomen
Back
- Buffalo hump may be present
Neuromuscular
- Patient is usually oriented to persons, place, and time
- Proximal/distal muscle weakness unilaterally/bilaterally may be present
- Bitemporal hemianopsia suggestive of cranial nerve VI compression by a pituitary tumor
Extremities
- Muscle atrophy may be present
References
- ↑ Burke CW (1985). "Adrenocortical insufficiency". Clin Endocrinol Metab. 14 (4): 947–76. PMID 3002680.
- ↑ Stacpoole PW, Interlandi JW, Nicholson WE, Rabin D (1982). "Isolated ACTH deficiency: a heterogeneous disorder. Critical review and report of four new cases". Medicine (Baltimore). 61 (1): 13–24. PMID 6276646.
- ↑ Charmandari E, Nicolaides NC, Chrousos GP (2014). "Adrenal insufficiency". Lancet. 383 (9935): 2152–67. doi:10.1016/S0140-6736(13)61684-0. PMID 24503135.
- ↑ Cuesta M, Garrahy A, Slattery D, Gupta S, Hannon AM, Forde H, McGurren K, Sherlock M, Tormey W, Thompson CJ (2016). "The contribution of undiagnosed adrenal insufficiency to euvolaemic hyponatraemia: results of a large prospective single-centre study". Clin. Endocrinol. (Oxf). 85 (6): 836–844. doi:10.1111/cen.13128. PMID 27271953.