Secondary adrenal insufficiency physical examination

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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
• Hyperthermia may be present
• Tachycardia may be present
• Normal to low blood pressure may be present

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

• No Jugular venous distension

Lungs

• Symmetric chest expansion
• Normal tactile fremitus

Heart

• PMI within 2 cm of the sternum (PMI)
• Friction rub
• S1
• S2

Abdomen

• No abdominal tenderness

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

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