GOOD MORNING

In The Name Of GOD

DR. MUHAMMAD O. MUHAMMADPREPARED BY DR. ALTUN M. SALEH

1ST YEAR IRAQI BOARD STUDENT13TH JUNE 2009

Addison’s Disease

History

• A 54 yr old man from Kalar attended medical advice c/o darkening of skin color for last 4 monthes.

• His condition started gradually associated with generalized malaise, fatigue, ↓appetite & wt. with frequent belching & hiccoughs.

• No fever, neither nausea nor vomiting, no epigastric pain, no change in bowel habit.

• No cardio-respiratory & genito-urinary complaint.

PMH: HTN on irregular treatment but during last 4 mo. he developed hypotension. Septic arthritis? of Lt. knee joint before 1 yr.

PSH: Lt. knee joint operation at 1989 & since that time fixed flexion deformity of Lt. knee joint.

DH: NKA

FH: Parents died (mother had stroke). He has 3 sisters & 3 brothers, all are healthy & 1 sister who died at age of 53 from renal failure. His wife is alive with hx. of TB at 1985. He has 5 sons & 3 daughters, all are healthy.

Social Hx: Chronic smoker, gave up smoking 7 mo. ago. Employer, own house, moderate socioeconomic state.

On examination

Conscious, dark skin, normal body build, not pale, Lt. knee joint swelling & deformity, no leg oedema.

PR=76/min Temp=37.9°CBP=80-90/60 mmHg RBS=100 mg/dl

Ht: NDR Chest: NVBAbdomen: Soft, no tenderness, no organ palpable

Investigations

• ECG, CXR, KUB• RBS, RFT, S. electrolytes, LFT• CBP, ESR• U/S of abdomen, OGD• Short synecthen test• CT of chest & adrenal glands• MRI of abdomen • TFT, S. Iron, TIBC, S. Ferritin

TFTMRI of abdomenS. IRON, TIBC, S. Ferritin; are waiting.

Treatment

Prednisolon tab. 5 mg at morningAnti-TB chemotherapy

Thank You