Clinical Problem-Solving: Identifying Addison's Disease

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Abstract
I stopped reading the Clinical Problem-Solving article by Keljo and Squires (Jan. 4 issue)1 when I reached the second line of the second column, which gives the erythrocyte sedimentation rate as 38 mm per hour. I was dissatisfied with the reasoning of the discussant in the first paragraph. None of the proposed differential diagnoses seemed appropriate. I started again and constructed my own differential diagnosis. My summary of diagnostic signs and symptoms included shortness of breath during exercise without wheezing or cough, loss of weight, amenorrhea, hypotension with an increased pulse rate, and a previous vaccination. I came to just one possibility — Addison's disease. My request for additional information at this stage would have concerned loss of appetite, nausea, the effect of exposure to sun, pigmentation of skin folds, orthostatic hypotension, the exact eosinophil count in circulating blood, and levels of glucose, sodium, and potassium.

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