Secondary adrenal insufficiency physical examination

Patients with secondary adrenal insufficiency usually appear weak or cushingoid (if the cause is glucocorticoid withdrawal). Physical examination of patients with secondary adrenal insufficiency is usually remarkable for cushingoid features like muscle weakness, buffalo hump. Hypotension may or may not be present. The absence of hyperpigmentation is the hallmark and a distinguishing feature of secondary adrenal insufficiency. Also, the presence of visual field defects like bitemporal hemianopsia indicates a pituitary tumor.

• Patients with secondary adrenal insufficiency usually appear weak and fatigued.
• They may present with cushingoid features if there is any history of prolonged steroid intake.

• Low-grade fever may be present
• Tachycardia may be present
• Hypotension-less common ^[1][2][3][4]
• No dehydration

• Pallor may be present
• Bruises may be present
• No hyperpigmentation
• Alabaster-coloured pale skin
• Loss of axillary or pubic hair

• Extra-ocular movements may be abnormal
• Visual field defects can be seen such as bitemporal hemianopsia

• No Jugular venous distension

• Symmetric chest expansion
• Normal tactile fremitus

• S1 , soft and normal
• S2 normal

• No abdominal tenderness

• Buffalo hump may be present

• Patient is usually oriented to persons, place, and time
• Proximal/distal muscle weakness unilaterally/bilaterally may be present
• Bitemporal hemianopsia suggestive of cranial nerve VI compression by a pituitary tumor

• Muscle atrophy may be present

• If associated with hypopituitarism, patient can present with any one of the following physical signs according to the respective hormonal deficiency:

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