A 34-year-old male complains of extreme fatigue and weakness, lightheadedness, anorexia, and unintentional weight loss of 20 pounds over the last month. The patient has a history of tuberculosis as a child from age 4
Current tuberculin PPD is pending. On physical examination, the patient is afebrile with heart rate 110 beats/min., resps 18 breaths / min, and BP 100/50. He has a tanned complexion, thin and frail looking, and looks younger than stated age. Heart: tachycardia, regular rate and rhythm. Lungs are clear to auscultation. Abdomen non-tender with no organomegaly. Extremities show no significant findings. No neurological deficits. C-x-ray demonstrates area of scar tissue. These signs and symptoms are characteristic of:
A. Congestive heart failure
B. Active tuberculosis
C. Cushing's disease
D. Addison's disease
ANS: D
Weakness and fatigue are early signs of Addison's disease. The patient may complain of lightheadedness, owing to volume depletion, and orthostatic hypotension is found on examination. In most cases, the skin and mucous membranes are hyperpigmented, especially over creases, bony prominences, and nipples. The patient may complain of anorexia, nausea, vomiting, or diarrhea, and weight loss is evident. Adrenal tuberculosis causes hypoadrenalism.
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