Patients with adrenal insufficiency usually appear dehydrated and weak. Physical examination of patients with primary adrenal insufficiency is usually remarkable for hyperpigmentation of skin.

Physical examination of patients with primary adrenal insufficiency is usually remarkable for hyperpigmentation of skin. ^[1]

• Patients with adrenal insufficiency usually appear dehydrated or weak.

• Fever maybe present in adrenal insufficiency. ^[2]
• Low blood pressure with normal pulse pressure is seen, especially in [[primary adrenal insufficiency due to mineralocorticoid deficiency.
• Adrenal crisis presents with hypotension, tachycardia, hypovolemia. ^[3]

• Skin examination of patients with primary adrenal insufficiency includes: ^[4]
• Hyperpigmentation, commonly affecting the palmar creases, perineum, axilla, and areola. It is most prominent in areas exposed to trauma, pressure and sun.
• Mucosal hyperpigmentation commonly effects buccal, gingival, tongue, vermillion border of lips. ^[5]
• Loss of axillary and pubic hair in women with primary adrenal insufficiency
• Horizontal bands of hyperpigmentation on the nails.
• Signs of dehydration such as dry mucous membranes^{_Endocrinology_|_JAMA_|_JAMA_Network-6|[6]}

Following image shows mucosal hyperpigmentation in Addison’s disease:

• HEENT examination of patients with adrenal insufficiency is usually normal.

• Neck examination of patients with adrenal insufficiency is usually normal.

• Pulmonary examination of patients with adrenal insufficiency is usually normal.

• Cardiovascular examination of patients with adrenal insufficiency is usually normal.

• Abdominal tenderness and guarding can be present in adrenal crisis ^[7]

• Back examination of patients with adrenal insufficiency is usually normal.

• Genitourinary examination of patients with adrenal insufficiency is usually normal.

• Altered mental status maybe seen in patients with adrenal crisis ^[8]

• Extremities examination of patients with adrenal insufficiency is usually normal.