CLINICAL DIAGNOSTIC MANUAL
Abnormal pigmentation of wrinkles, body flexures, and the oral mucosa can indicate underlying hormonal imbalances, particularly those related to the hypothalamic-pituitary-adrenal axis.
This pigmentation is often a result of increased adrenocorticotropic hormone (ACTH) levels due to various endocrine pathologies. Identifying and assessing abnormal pigmentation is crucial for the proper diagnosis and treatment of these conditions.
Pathology | Symptoms and Clinical Signs | Suspected Diagnosis | Confirmed Diagnosis |
Addison’s Disease | Fatigue, muscle weakness, weight loss, hypotension, nausea, vomiting. Hyperpigmentation of skin and mucosa. | Clinical history and physical examination. Elevated ACTH and low cortisol levels. | Confirmation with ACTH stimulation test. CT/MRI of adrenal glands. |
Cushing’s Disease | Weight gain, moon face, fatigue, muscle weakness, hypertension, hyperglycaemia. Purplish stretch marks, thin skin. | Clinical history and physical examination. Elevated cortisol levels. | Confirmation with dexamethasone suppression test. CT/MRI of adrenal glands or pituitary gland. |
Ectopic ACTH Secretion | Symptoms similar to Cushing’s syndrome. Generalised hyperpigmentation. | Clinical history and physical examination. Very high ACTH and cortisol levels. | Confirmation with CT/MRI to locate the ectopic ACTH-producing tumour. |
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