From the Guidelines
Addison's disease is characterized by distinct physical features, including hyperpigmentation, weight loss, postural hypotension, muscle weakness, and fatigue, which are a result of insufficient adrenal hormone production. The most noticeable physical sign is hyperpigmentation, where the skin darkens, particularly in sun-exposed areas, skin folds, scars, and pressure points, due to increased ACTH production stimulating melanin production 1. Patients often develop weight loss and appear gaunt or emaciated due to decreased appetite, nausea, and metabolic changes. Postural hypotension is common, causing dizziness when standing up quickly, and muscle weakness and fatigue are prominent features as cortisol and aldosterone deficiencies affect energy metabolism and electrolyte balance. Some patients develop vitiligo (patches of depigmented skin) due to the autoimmune nature of the disease. Women may experience loss of body hair, while both sexes can develop salt cravings due to sodium loss from aldosterone deficiency. In advanced cases, patients may show signs of dehydration including dry mucous membranes and poor skin turgor. These physical manifestations typically develop gradually but become more pronounced as the disease progresses, making early recognition challenging but crucial for proper management. Key physical features of Addison's disease include:
- Hyperpigmentation
- Weight loss
- Postural hypotension
- Muscle weakness
- Fatigue
- Vitiligo
- Loss of body hair in women
- Salt cravings
- Dehydration signs such as dry mucous membranes and poor skin turgor. The diagnosis of Addison's disease should be considered in patients presenting with unexplained collapse, hypotension, vomiting, or diarrhea, and hyperpigmentation, hyponatremia, hyperkalemia, acidosis, and hypoglycemia increase clinical suspicion of primary adrenal insufficiency 1.
From the Research
Physical Features of Addison's Disease
The physical features of Addison's disease include:
- Hyperpigmentation of the skin and mucosal surfaces, which can be severe 2
- Darkening of the skin, especially in sun-exposed areas 3
- Hyperpigmentation of the palmar creases, frictional surfaces, vermilion border, recent scars, genital skin, and oral mucosa 3
- Orthostatic hypotension, which is a significant drop in blood pressure when standing up 3, 4
- Hypotension, which is low blood pressure 2
- Weight loss, which can be significant, such as 7 Kg in four weeks 2
- Fatigue, which is a common symptom of Addison's disease 2, 3, 4
- Anorexia, which is a loss of appetite 2, 3, 4
- Muscle and joint pain 4
- Salt craving 4
- Nausea 4
Cutaneous Manifestations
The cutaneous manifestations of Addison's disease include:
- Hyperpigmentation of the skin, which can be diffuse or localized 3
- Darkening of the skin in sun-exposed areas, such as the face, hands, and feet 3
- Hyperpigmentation of the palmar creases, frictional surfaces, and recent scars 3
- Hyperpigmentation of the genital skin and oral mucosa 3
Other Physical Features
Other physical features of Addison's disease include: