1/4. Addisonian crisis presenting with a normal short tetracosactrin stimulation test.We report the case of a 70 year old man who presented with physical and biochemical features suggestive of Addison's disease, but had a normal short tetracosactrin (Synacthen) test. Six months later he re-presented with similar clinical features but with an abnormal response to tetracosactrin confirming the diagnosis of Addison's disease. We recommend that if adrenal insufficiency is strongly suggested further investigation should be performed to exclude this diagnosis.- - - - - - - - - - ranking = 1keywords = physical (Clic here for more details about this article) |
2/4. Atypical presentation of shock from acute adrenal insufficiency in an adolescent male.OBJECTIVE: To report an atypical presentation of shock and acute adrenal insufficiency in an adolescent male. CASE SUMMARY: A 14-year-old boy with a history of nocturnal enuresis presented with a clinical picture suggestive of septic shock refractory to aggressive fluid and vasopressor management. history and physical examination were suggestive of shock secondary to an infectious etiology, associated with skin findings of hyperpigmentation. The laboratory studies were remarkable for normal sodium, potassium, glucose, as well as normal renin levels. hydrocortisone therapy led to improvement of his blood pressure and allowed weaning of vasopressor medications. Further laboratory studies, including adrenocorticotropic hormone stimulation test and adrenal antibodies, confirmed the diagnosis of primary adrenal insufficiency. CONCLUSION: Acute adrenal insufficiency is an uncommon cause of shock in the adolescent population. We report a clinical presentation suggestive of shock secondary to acute adrenal insufficiency remarkable for an atypical clinical and laboratory presentation. We further provide information on the management of acute adrenal crisis.- - - - - - - - - - ranking = 14.127588666477keywords = physical examination, physical (Clic here for more details about this article) |
3/4. Addison's disease presenting as anorexia nervosa in a young man.A young man with a long history of obsessional traits and food fads presented with anorexia, vomiting and marked weight loss. He showed little concern for his physical state and his vomiting was frequently witnessed as self-induced. A diagnosis of anorexia nervosa was made and he took his own discharge from hospital. He was readmitted one month later, severely cachectic and with biochemical abnormalities consistent with advanced Addison's disease which was subsequently confirmed. He responded dramatically, both mentally and physically, to corticosteroid therapy. It is likely that anorexia nervosa, relatively rare in males, was a manifestation of the psychological abnormalities commonly seen in severe Addison's disease.- - - - - - - - - - ranking = 2keywords = physical (Clic here for more details about this article) |
4/4. patients presenting with Addison's disease need not be pigmented.Three consecutive cases of Addison's disease without increased pigmentation are described. We suggest that the absence of this important physical sign contributed to serious delays in diagnosis and markedly increased morbidity. We emphasize that, despite the usual textbook description, excess pigmentation is not necessarily a feature of Addison's disease.- - - - - - - - - - ranking = 1keywords = physical (Clic here for more details about this article) |