A 63-year-old woman presented with increasing darkening of the skin, dizziness, easy fatigability, nausea with occasional vomiting, and progressive weight loss over 8 months prior to presentation. Physical examination showed a pulse of 106 bpm, supine blood pressure was 100/60 mm Hg and 70/40 mm Hg on sitting. She could not stand on account of severe postural dizziness. Radiological diagnostic tests included an abdominal ultrasound showing normal liver, spleen, pancreas, and pelvic organs. However, the left kidney was not outlined. A CT scan of the abdomen showed a nonenhancing oval-shaped left suprarenal mass with calcification. The signs and symptom in this patient are most likely the result of which of the following?

Question

Quizplus · Accepted Answer

The symptoms and CT findings are consistent with Addison's disease, which is caused by adrenal insufficiency. The nonenhancing mass with calcification in the left adrenal gland suggests adrenal damage or destruction, leading to the symptoms of skin darkening, dizziness, fatigue, nausea, and hypotension.  Addison disease is characterized by general malaise and debility, irritability of the stomach, and hyperpigmentation. The disease results from a primary failure of the adrenal cortex to synthesize and secrete glucocorticoid (cortisol) and mineralocorticoid (aldosterone) hormones. One of the most common causes of Addison disease is an adrenocortical adenoma which in this case is evident from the CT scan showing a suprarenal mass.

A 63-Year-Old Woman Presented with Increasing Darkening of the Skin