1. GOOD MORNING In The Name Of GOD

2. DR. MUHAMMAD O. MUHAMMAD PREPARED BY DR. ALTUN M. SALEH 1 STYEAR IRAQI BOARD STUDENT 13 THJUNE 2009 Addisons Disease 3. 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.

4.

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

5.

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.

6. On examination

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

PR=76/minTemp=37.9C

BP=80-90/60 mmHgRBS=100 mg/dl

Ht:NDRChest: NVB

Abdomen:Soft, no tenderness, no organ palpable

7. 8. 9. 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

10. 11. 12. 13. 14. 15. 16. 17. 18.

TFT

MRI of abdomen

S. IRON, TIBC, S. Ferritin; are waiting.

19. Treatment

Prednisolon tab. 5 mg at morning

Anti-TB chemotherapy

20. Thank You